External beam radiotherapy plus high-dose-rate brachytherapy for treatment of locally advanced prostate cancer: The initial experience of the Catalan Institute of Oncology

Pistis, Francesca; Guedea, Ferran; Pera, Joan; Gutierrez, Cristina; Ventura, Montse; Polo, Alfredo; Martinez, Evelyn; Boladeras, Ana; Ferrer, Ferran; Gabriele, Pietro; Linares, Luis

doi:10.1016/j.brachy.2009.05.001

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Volume 9, Issue 1 , Pages 15-22, January 2010

External beam radiotherapy plus high-dose-rate brachytherapy for treatment of locally advanced prostate cancer: The initial experience of the Catalan Institute of Oncology

Francesca Pistis
- Department of Radiation Oncology, Regional Centre of Radiotherapy and Nuclear Medicine, Cagliari, Italy
Ferran Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, Universidad de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
- Corresponding author. Department of Radiation Oncology, Catalan Institute of Oncology (ICO), University of Barcelona (UB), Gran vía s/n, Km 2, 7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. Tel.: +34-93-2607722; fax: +34-93-2607725.
Joan Pera
- Department of Radiation Oncology, Catalan Institute of Oncology, Universidad de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Universidad de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
Montse Ventura
- Department of Radiation Oncology, Catalan Institute of Oncology, Universidad de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
Alfredo Polo
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
Evelyn Martinez
- Department of Radiation Oncology, Catalan Institute of Oncology, Universidad de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
Ana Boladeras
- Department of Radiation Oncology, Catalan Institute of Oncology, Universidad de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
Ferran Ferrer
- Department of Radiation Oncology, Catalan Institute of Oncology, Universidad de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
Pietro Gabriele
- Department of Radiation Oncology, Regional Centre of Radiotherapy and Nuclear Medicine, Cagliari, Italy
Luis Linares
- East Jefferson General Hospital, New Orleans, LA

Received 17 September 2008; received in revised form 8 January 2009; accepted 7 May 2009. published online 07 September 2009.

Abstract

Purpose

The objective of this study was to report initial outcomes in patients with locally advanced prostate cancer (CaP) who underwent external beam radiation therapy (EBRT) treatment combined with high-dose-rate brachytherapy (HDR-BT) as a boost.

Methods and Materials

From 2002 to 2007, 114 CaP patients underwent EBRT followed by ¹⁹²I HDR-BT. The patients were classified into intermediate- (Group 1) or high- (Group 2) risk groups. The mean total EBRT dose was 60.0Gy (95% confidence interval [CI]: 59.9–60.1) at 2Gy per fraction. After a mean of 20.6 days (95% CI: 18.4–22.8), all the patients received a single-fraction 9-Gy dose of HDR-BT boost. Of the 114 patients in the study, 103 (90.4%) underwent up to 3 years of complete androgen deprivation therapy after diagnosis.

Results

The mean followup for the entire group was 32.1 months (95% CI: 29.9–34.4). The 4-year biochemical failure-free survival rate was 97.4% and treatment was well-tolerated.

Conclusions

Preliminary biochemical control rates after EBRT plus one fraction of 9-Gy HDR-BT are encouraging. This atypical fractionation schedule is cost-effective and reduces patient discomfort and treatment-related risks. More followup is required to confirm these findings.

Keywords: Brachytherapy, Prostate cancer, HDR, Toxicity, Boost