title: American Brachytherapy Society Task Group Report: Combination of brachytherapy and external beam radiation for high-risk prostate cancer.
abstract: To review outcomes for high-risk prostate cancer treated with combined modality radiation therapy (CMRT) utilizing external beam radiation therapy (EBRT) with a brachytherapy boost.
  
  
  
  The available literature for high-risk prostate cancer treated with combined modality radiation therapy was reviewed and summarized.
  
  
  
  At this time, the literature suggests that the majority of high-risk cancers are curable with multimodal treatment. Several large retrospective studies and three prospective randomized trials comparing CMRT to dose-escalated EBRT have demonstrated superior biochemical control with CMRT. Longer followup of the randomized trials will be required to determine if this will translate to a benefit in metastasis-free survival, disease-specific survival, and overall survival. Although greater toxicity has been associated with CMRT compared to EBRT, recent studies suggest that technological advances that allow better definition and sparing of critical adjacent structures as well as increasing experience with brachytherapy have improved implant quality and the toxicity profile of brachytherapy. The role of androgen deprivation therapy is well established in the external beam literature for high-risk disease, but there is controversy regarding the applicability of these data in the setting of dose escalation. At this time, there is not sufficient evidence for the omission of androgen deprivation therapy with dose escalation in this population. Comparisons with surgery remain limited by differences in patient selection, but the evidence would suggest better disease control with CMRT compared to surgery alone.
  
  
  
  Due to a series of technological advances, modern combination series have demonstrated unparalleled rates of disease control in the high-risk population. Given the evidence from recent randomized trials, combination therapy may become the standard of care for high-risk cancers.
authors: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
authors: Daniel E
authors: DE
authors: Spratt
authors: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
authors: Payal D
authors: PD
authors: Soni
authors: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI. Electronic address: mclaughb@med.umich.edu.
authors: Patrick W
authors: PW
authors: McLaughlin
authors: Schiffler Cancer Center, Department of Radiation Oncology, Wheeling Jesuit University, Wheeling, WV; Department of Urology, Wheeling Hospital, Wheeling, WV.
authors: Gregory S
authors: GS
authors: Merrick
authors: Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Richard G
authors: RG
authors: Stock
authors: Retired, Seattle, WA.
authors: John C
authors: JC
authors: Blasko
authors: Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY.
authors: Michael J
authors: MJ
authors: Zelefsky
mesh_terms: D026683:Advisory Committees; D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy*; D018787:Radiation Oncology; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D012955:Societies, Medical; D015996:Survival Rate; D014481:United States
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen
keywords: Combination brachytherapy and external beam radiation; High-risk prostate cancer; Prostate cancer therapy