High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up.
The purpose of this study was to report the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT) for National Comprehensive Cancer Network (NCCN) criteria-defined high-risk (HR) and very high-risk (VHR) prostate cancer. Data from 178 HR (n = 96, 54%) and VHR (n = 82, 46%) prostate cancer patients who underwent (192)Ir-HDR brachytherapy and hypofractionated EBRT with long-term ADT between 2003 and 2008 were retrospectively analyzed. The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After five fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administered. All patients initially underwent ≥ 6 months of neoadjuvant ADT, and adjuvant ADT was continued for 36 months after EBRT. The median follow-up was 61 months (range, 25-94 months) from the start of radiotherapy. The 5-year biochemical non-evidence of disease, freedom from clinical failure and overall survival rates were 90.6% (HR, 97.8%; VHR, 81.9%), 95.2% (HR, 97.7%; VHR, 92.1%), and 96.9% (HR, 100%; VHR, 93.3%), respectively. The highest Radiation Therapy Oncology Group-defined late genitourinary toxicities were Grade 2 in 7.3% of patients and Grade 3 in 9.6%. The highest late gastrointestinal toxicities were Grade 2 in 2.8% of patients and Grade 3 in 0%. Although the 5-year outcome of this tri-modality approach seems favorable, further follow-up is necessary to validate clinical and survival advantages of this intensive approach compared with the standard EBRT approach.
Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara 252-0329, Japan.
Hiromichi
H
Ishiyama
Takefumi
T
Satoh
Masashi
M
Kitano
Ken-ichi
K
Tabata
Shouko
S
Komori
Masaomi
M
Ikeda
Itaru
I
Soda
Shinji
S
Kurosaka
Akane
A
Sekiguchi
Masaki
M
Kimura
Shogo
S
Kawakami
Masatsugu
M
Iwamura
Kazushige
K
Hayakawa
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000008:administration & dosage*; D001918:Brachytherapy / Q000401:mortality*; D059248:Chemoradiotherapy / Q000401:mortality*; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone
androgen deprivation therapy; high-dose-rate brachytherapy; high-risk; prostate cancer; very high-risk