title: High-dose rate brachytherapy as monotherapy in prostate cancer: A systematic review of its safety and efficacy.
abstract: BACKGROUND
  High-dose rate brachytherapy (HDR-BT) is an increasingly popular treatment for patients with localised prostate cancer (PC).
  
  
  OBJECTIVE
  To assess the safety and efficacy of HDR-BT as monotherapy in PC.
  
  
  METHODS
  A systematic literature review was conducted through searches on MEDLINE (PubMed), Cochrane Library, CDR, ClinicalTrials and EuroScan. We assessed safety and efficacy indicators.
  We selected 2 reviews and 12 uncontrolled studies, included in these 2 reviews. In terms of efficacy, local control in 6 studies was 97-100%. The biochemical progression-free survival varied as follows: 85-100% for low risk and 79-92% for high risk. Survival free of metastases was >95% at 8 years, except in one study where the survival rate was 87% at 5 years. The overall survival was ≥95% in 8 studies. In terms of safety, most of the studies recorded acute and long-term genitourinary and gastrointestinal complications, especially grade ≥2. Only 3 studies found grade 4 complications. All studies, except for one without complications, observed genitourinary complications that were more frequent and severe than the gastrointestinal complications. Two studies assessed the quality of life and showed an initial reduction in various domains and subsequent partial or total recovery, except in the sexual domain.
  
  
  CONCLUSIONS
  HDR-BT is effective as monotherapy, especially in cases of low to intermediate risk. There is insufficient information on high-risk patients. The short to medium-term toxicity was acceptable. Further research needs to be funded to provide more information on the long-term safety and efficacy of this treatment.
authors: Agencia de Evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III (ISCIII), Ministerio de Economía y Competitividad, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa (IP), Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España. Electronic address: luism.sanchez@isciii.es.
authors: L M
authors: LM
authors: Sánchez-Gómez
authors: Agencia de Evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III (ISCIII), Ministerio de Economía y Competitividad, Madrid, España.
authors: M
authors: M
authors: Polo-deSantos
authors: Servicio de Oncología Radioterápica, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.
authors: J I
authors: JI
authors: Rodríguez-Melcón
authors: Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España.
authors: J C
authors: JC
authors: Angulo
authors: Agencia de Evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III (ISCIII), Ministerio de Economía y Competitividad, Madrid, España.
authors: S
authors: S
authors: Luengo-Matos
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
keywords: Braquiterapia de alta tasa de dosis; Cáncer de próstata; High-dose rate brachytherapy; Prostate cancer; Radiation therapy; Radioterapia; Revisión sistemática; Systematic review