High-dose-rate interstitial brachytherapy in combination with androgen deprivation therapy for prostate cancer: are high-risk patients good candidates?
OBJECTIVE
To evaluate the effectiveness of high-dose-rate interstitial brachytherapy (HDR-ISBT) as the only form of radiotherapy for high-risk prostate cancer patients.


METHODS
Between July 2003 and June 2008, we retrospectively evaluated the outcomes of 48 high-risk patients who had undergone HDR-ISBT at the National Hospital Organization Osaka National Hospital. Risk group classification was according to the criteria described in the National Comprehensive Cancer Network (NCCN) guidelines. Median follow-up was 73 months (range 12-109 months). Neoadjuvant androgen deprivation therapy (ADT) was administered to all 48 patients; 12 patients also received adjuvant ADT. Maximal androgen blockade was performed in 37 patients. Median total treatment duration was 8 months (range 3-45 months). The planned prescribed dose was 54 Gy in 9 fractions over 5 days for the first 13 patients and 49 Gy in 7 fractions over 4 days for 34 patients. Only one patient who was over 80 years old received 38 Gy in 4 fractions over 3 days. The clinical target volume (CTV) was calculated for the prostate gland and the medial side of the seminal vesicles. A 10-mm cranial margin was added to the CTV to create the planning target volume (PTV).


RESULTS
The 5-year overall survival and biochemical control rates were 98 and 87 %, respectively. Grade 3 late genitourinary and gastrointestinal complications occurred in 2 patients (4 %) and 1 patient (2 %), respectively; grade 2 late genitourinary and gastrointestinal complications occurred in 5 patients (10 %) and 1 patient (2 %), respectively.


CONCLUSIONS
Even for high-risk patients, HDR-ISBT as the only form of radiotherapy combined with ADT achieved promising biochemical control results, with acceptable late genitourinary and gastrointestinal complication rates.
Department of Radiology, Osaka Medical College, 2-7, Daigaku-machi, 569-8686, Takatsuki, Osaka, Japan, rad113@poh.osaka-med.ac.jp.
Ken
K
Yoshida
Hideya
H
Yamazaki
Tadashi
T
Takenaka
Tadayuki
T
Kotsuma
Mineo
M
Yoshida
Koji
K
Masui
Yasuo
Y
Yoshioka
Yoshifumi
Y
Narumi
Toshitsugu
T
Oka
Eiichi
E
Tanaka
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D018572:Disease-Free Survival; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011471:Prostatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology*
D000726:Androgen Antagonists