Feasibility and Toxicity of a Single Fraction High-dose-rate Brachytherapy Followed by a Course of EBRT for Localized Prostate Cancer: the French Experience about 100 Patients; A Retrospective Study

Purpose/Objective(s)Evaluate the feasibility and toxicity of radiation dose escalation delivered with a single fraction high-dose-rate (HDR) brachytherapy boost followed by external beam radiotherapy (EBRT) for intermediate and high risk localized prostate cancer - a retrospective study.Materials/MethodsBetween January 2005 and April 2010, 100 patients with intermediate or high-risk localized prostate cancer were treated by a single 10 Gy fraction of interstitial HDR brachytherapy followed by a 64 Gy course of external beam radiation therapy. Dose volume histograms, conformity index and side effects were systematically analyzed.ResultsHDR brachytherapy dosimetric criteria were respected. Few early side effects were reported: only 30 % and 26 % patients presented a grade 2 or 3 urinary or bowel toxicity respectively, mostly during EBRT course. One patient presented a grade 4 urinary toxicity, which had spontaneously regressed 3 weeks after brachytherapy. Late toxicity (after 3 months) was mild or moderate with 12 % and 5 % grade 2 or grade 3 urinary or bowel toxicity respectively. No patients reported any grade 4 late toxicity events. Erectile dysfunction was not reported because of a large number of patients treated with androgenic blockade. With a median follow-up of 21 months, no PSA progression was observed.ConclusionsSingle fraction HDR brachytherapy followed by EBRT is feasible with little toxicity. It presents also many advantages mostly in terms of organization, and allows treatment for high risk localized prostate cancer. Longer follow-up is required to evaluate the results in term of biological relapse free survival. Purpose/Objective(s)Evaluate the feasibility and toxicity of radiation dose escalation delivered with a single fraction high-dose-rate (HDR) brachytherapy boost followed by external beam radiotherapy (EBRT) for intermediate and high risk localized prostate cancer - a retrospective study. Evaluate the feasibility and toxicity of radiation dose escalation delivered with a single fraction high-dose-rate (HDR) brachytherapy boost followed by external beam radiotherapy (EBRT) for intermediate and high risk localized prostate cancer - a retrospective study. Materials/MethodsBetween January 2005 and April 2010, 100 patients with intermediate or high-risk localized prostate cancer were treated by a single 10 Gy fraction of interstitial HDR brachytherapy followed by a 64 Gy course of external beam radiation therapy. Dose volume histograms, conformity index and side effects were systematically analyzed. Between January 2005 and April 2010, 100 patients with intermediate or high-risk localized prostate cancer were treated by a single 10 Gy fraction of interstitial HDR brachytherapy followed by a 64 Gy course of external beam radiation therapy. Dose volume histograms, conformity index and side effects were systematically analyzed. ResultsHDR brachytherapy dosimetric criteria were respected. Few early side effects were reported: only 30 % and 26 % patients presented a grade 2 or 3 urinary or bowel toxicity respectively, mostly during EBRT course. One patient presented a grade 4 urinary toxicity, which had spontaneously regressed 3 weeks after brachytherapy. Late toxicity (after 3 months) was mild or moderate with 12 % and 5 % grade 2 or grade 3 urinary or bowel toxicity respectively. No patients reported any grade 4 late toxicity events. Erectile dysfunction was not reported because of a large number of patients treated with androgenic blockade. With a median follow-up of 21 months, no PSA progression was observed. HDR brachytherapy dosimetric criteria were respected. Few early side effects were reported: only 30 % and 26 % patients presented a grade 2 or 3 urinary or bowel toxicity respectively, mostly during EBRT course. One patient presented a grade 4 urinary toxicity, which had spontaneously regressed 3 weeks after brachytherapy. Late toxicity (after 3 months) was mild or moderate with 12 % and 5 % grade 2 or grade 3 urinary or bowel toxicity respectively. No patients reported any grade 4 late toxicity events. Erectile dysfunction was not reported because of a large number of patients treated with androgenic blockade. With a median follow-up of 21 months, no PSA progression was observed. ConclusionsSingle fraction HDR brachytherapy followed by EBRT is feasible with little toxicity. It presents also many advantages mostly in terms of organization, and allows treatment for high risk localized prostate cancer. Longer follow-up is required to evaluate the results in term of biological relapse free survival. Single fraction HDR brachytherapy followed by EBRT is feasible with little toxicity. It presents also many advantages mostly in terms of organization, and allows treatment for high risk localized prostate cancer. Longer follow-up is required to evaluate the results in term of biological relapse free survival.