title: External beam radiotherapy plus single-fraction high dose rate brachytherapy in the treatment of locally advanced prostate cancer.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) plus high-dose-rate brachytherapy (HDRB) as a boost in patients (pts) with intermediate or high-risk prostate cancer.
  
  
  METHODS
  From 2002 to July 2012, 377 pts with a diagnosis of intermediate or high-risk prostate cancer were treated with EBRT plus HDRB. Median patient age was 66 years (range, 41-86). Most patients (347 pts; 92%) were classified as high-risk (stage T2c-T3, or PSA>20 ng/mL, or GS ⩾ 8), with 30 patients (8%) considered intermediate risk. All patients underwent EBRT at a prescribed dose of 60.0 Gy (range, 45-70 Gy) to the prostate and seminal vesicles. A total of 120 pts (31%) received a dose of 46 Gy (45-50 Gy) to the true pelvis. All pts received a single-fraction 9 Gy (9-15 Gy) HDR boost. Most patients (353; 94%) were prescribed complete androgen deprivation therapy (ADT). Overall survival (OS), cause-specific survival (CSS), and biochemical relapse-free survival (BRFS) rates were calculated. In the case of BRFS, patients with <26 months of follow-up (n=106) were excluded to minimize the impact of ADT.
  
  
  RESULTS
  The median follow-up for the entire sample was 50 months (range, 12-126), with 5-year actuarial OS and CSS, respectively, of 88% (95% confidence interval [CI]: 84-92) and 98% (95% CI: 97-99). The 5-year BRFS was 91% (95% CI: 87-95) in the 271 pts with ⩾ 26 months (median, 60 months) of follow-up. Late toxicity included grade 2 and 3 gastrointestinal toxicity in 17 (4.6%) and 6 pts (1.6%), respectively, as well as grades 2 and 3 genitourinary toxicity in 46 (12.2%) and 3 pts (0.8%), respectively.
  
  
  CONCLUSIONS
  These long-term outcomes confirm that EBRT plus a single-fraction HDRB boost provides good results in treatment-related toxicity and biochemical control. In addition to the excellent clinical results, this fractionation schedule reduces physician workload, treatment-related expenses, patient discomfort and risks associated with anaesthesia. We believe these findings support the use of single-fractionation boost techniques.
authors.affiliation: Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Boladeras
authors.affiliation: Department of Radiation Oncology, Policlinico di Bari, Universitá degli Studi di Bari, Italy.
authors.forename: Luigina
authors.initials: L
authors.lastname: Santorsa
authors.affiliation: Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gutierrez
authors.affiliation: Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Martinez
authors.affiliation: Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Pera
authors.affiliation: Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Pino
authors.affiliation: Department of Urology, Hospital de Bellvitge, Barcelona, Spain.
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Suarez
authors.affiliation: Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Ferrer
authors.affiliation: Department of Radiation Oncology, Grupo Quirón, Madrid, Spain.
authors.forename: Aurora
authors.initials: A
authors.lastname: Díaz
authors.affiliation: Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Polo
authors.affiliation: Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain. Electronic address: guedea@iconcologia.net.
authors.forename: Ferran
authors.initials: F
authors.lastname: Guedea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D006801:Humans; D007496:Iridium Radioisotopes / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007496:Iridium Radioisotopes
keywords: Boost; Brachytherapy; EBRT; HDRB; Prostate