Nationwide, Multicenter, Retrospective Study on High-Dose-Rate Brachytherapy as Monotherapy for Prostate Cancer.
To present, analyze, and discuss results of a nationwide, multicenter, retrospective study on high-dose-rate brachytherapy (HDR-BT) as monotherapy for low-, intermediate-, and high-risk prostate cancer.



From 1995 through 2013, 524 patients, 73 (14%) with low-risk, 207 (40%) with intermediate-risk, and 244 (47%) with high-risk prostate cancer, were treated with HDR-BT as monotherapy at 5 institutions in Japan. Dose fractionations were 27 Gy/2 fractions for 69 patients (13%), 45.5 Gy/7 fractions for 168 (32%), 49 Gy/7 fractions for 149 (28%), 54 Gy/9 fractions for 130 (25%), and others for 8 (2%). Of these patients, 156 (30%) did not receive androgen deprivation therapy, and 202 patients (39%) did receive androgen deprivation therapy <1 year, 112 (21%) for 1-3 years, and 54 (10%) for >3 years. Median follow-up time was 5.9 years (range, 0.4-18.1 years), with a minimum of 2 years for surviving patients.



After 5 years, respective actuarial rates of no biochemical evidence of disease, overall survival, cause-specific survival, and metastasis-free survival for all patients were 92%, 97%, 99%, and 94%. For low/intermediate/high-risk patients, the 5-year no biochemical evidence of disease rates were 95%/94%/89%, the 5-year overall survival rates were 98%/98%/94%, the 5-year cause-specific survival rates were 98%/100%/98%, and the 5-year metastasis-free survival rates were 98%/95%/90%, respectively. The cumulative incidence of late grade 2 to 3 genitourinary toxicity at 5 years was 19%, and that of late grade 3 was 1%. The corresponding incidences of gastrointestinal toxicity were 3% and 0% (0.2%). No grade 4 or 5 of either type of toxicity was detected.



The findings of this nationwide, multicenter, retrospective study demonstrate that HDR-BT as monotherapy was safe and effective for all patients with low-, intermediate-, and high-risk prostate cancer.
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: yoshioka@radonc.med.osaka-u.ac.jp.
Yasuo
Y
Yoshioka
Department of Radiation Oncology, Osaka National Hospital, Osaka, Japan.
Tadayuki
T
Kotsuma
Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan; Department of Urology, Chiba University Hospital, Chiba, Japan.
Akira
A
Komiya
Department of Radiology, Kochi Medical School, Kochi, Japan.
Shinji
S
Kariya
Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Koji
K
Konishi
Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan.
Norio
N
Nonomura
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.
Kazuhiko
K
Ogawa
Department of Radiation Oncology, Osaka National Hospital, Osaka, Japan.
Eiichi
E
Tanaka
Department of Urology, Osaka National Hospital, Osaka, Japan.
Kensaku
K
Nishimura
Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan.
Yasuyoshi
Y
Fujiuchi
Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan.
Hiroshi
H
Kitamura
Department of Radiology, Kochi Medical School, Kochi, Japan.
Takuji
T
Yamagami
Department of Urology, Kochi Medical School, Kochi, Japan.
Ichiro
I
Yamasaki
Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Kazuo
K
Nishimura
Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Teruki
T
Teshima
Department of Radiation Oncology, Hamamatsu University School of Medicine, Shizuoka, Japan.
Katsumasa
K
Nakamura
Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
Jun
J
Itami
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000401:mortality* / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005767:Gastrointestinal Diseases / Q000401:mortality* / Q000517:prevention & control; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000401:mortality* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome