To compare the long-term oncologic outcomes of intermediate risk (IR) prostate cancer (PCa) patients treated with low dose-rate brachytherapy (LDR-BT) or moderate hypofractionated external beam radiotherapy (HF-EBRT).
METHODS AND MATERIALS
Patients diagnosed with IR PCa and treated with LDR-BT or HF-EBRT between January 2005 and December 2013 were included. Brachytherapy treatment involved a transperineal implant of iodine-125 to a dose of 145 Gy to the PTV, while HF-EBRT was delivered using intensity modulated radiotherapy with 60 Gy in 20 fractions. The Phoenix ‘‘nadir +2’’ threshold was used to define biochemical relapse (BR). The cumulative incidence function (CIF) of BR and metastases was reported for each group and compared using the Gray's test to account for the competing risk of death. The Kaplan-Meier (KM) method was used to estimate overall survival (OS) and prostate cancer specific survival (PCSS). Univariate (UVA) and multivariable (MVA) analysis of the CIF of BR and metastases were performed. A 2-tailed p-value ≤ 0.05 was considered statistically significant.
Overall, 122 and 124 patients were treated with LDR-BT and HF-EBRT respectively. Median follow-up was 95 months [interquartile range (IQR): 79–118] in the LDR-BT group and 96 months (IQR: 63–123) in the HF-EBRT group. BR was observed in 5 patients treated with LDR-BT and 34 treated with HF-EBRT. At 60 and 90 months, the CIF of BR was 0.9% and 3.5% in the LDR-BT group vs. 16.6% and 23.7% in the HF-EBRT (p < 0.001). The CIF of metastases at 90 and 108 months, was 0% and 1.6% vs. 3.4% and 9.1% in the LDR-BT and HF-EBRT groups (p = 0.003), respectively. At the last follow-up, 3 patients treated with HF-EBRT died from their cancer [PCSS of 97.5% at 8 years and none died in the LDR-BT group (p = 0.09). On UVA and MVA risk group and treatment modality were independently associated with CIF of BR. On UVA HF-EBRT and ISUP grade group 3 were associated with metastases.
LDR-BT was associated with higher biochemical and metastases control in our cohort when compared to moderately HF-EBRT. In the absence of a randomized trial, LDR-BT when feasible should be offered to patients with a life expectancy of >8 years.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Brachytherapy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy >72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1–T2 prostate cancer.Int J Radiat Oncol Biol Phys. 2004; 58: 25-33
- Population-based 10-year oncologic outcomes after low-dose-rate brachytherapy for low-risk and intermediate-risk prostate cancer.Cancer. 2013; 119: 1537-1546
- Outcomes following iodine-125 brachytherapy in patients with Gleason 7, intermediate risk prostate cancer: A population-based cohort study.Radiother Oncol. 2012; 103: 228-232
- Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5, 969 patients in seven international institutional datasets: α/β = 1.4 (0.9-2.2) Gy.Int J Radiat Oncol Biol Phys. 2012; 82: e17-e24https://doi.org/10.1016/j.ijrobp.2010.10.075
- Confirmation of a low α/β ratio for prostate cancer treated by external beam radiation therapy alone using a post-treatment repeated-measures model for PSA dynamics.Int J Radiat Oncol Biol Phys. 2011; 79: 195-201https://doi.org/10.1016/j.ijrobp.2009.10.008
- The prostate cancer risk stratification project: Database construction and risk stratification outcome analysis.J Natl Compr Canc Netw. 2014; 12: 60-69
- Brachytherapy improves biochemical failure-free survival in low- and intermediate-risk prostate cancer compared with conventionally fractionated external beam radiation therapy: A propensity score matched analysis.Int J Radiat Oncol Biol Phys. 2015; 91: 505-516
- Randomized trial of a hypofractionated radiation regimen for the treatment of localized prostate cancer.J Clin Oncol. 2017; 35: 1884-1890https://doi.org/10.1200/JCO.2016.71.7397
- Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomized, non-inferiority, phase III CHHiP trial.Lancet Oncol. 2016; 17: 1047-1060
- Prostate.AJCC Cancer Staging Manual. 8th ed. Springer, New York, NY2017: 715-725
- A biochemical definition of cure after brachytherapy for prostate cancer.Radiother Oncol. 2020; 149 (Doi:): 64-69https://doi.org/10.1016/j.radonc.2020.04.038
- NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Prostate Cancer.2022 (Version 4Available at)Accessed July 6, 2022)
- Regression Modeling Strategies, Frank Harrell.Springer-Verlag, NY2001
- American society for therapeutic radiology and oncology consensus panel.Int J Radiat Oncol Biol Phys. 1997; 37: 1035-1041
- PSA nadir predicts biochemical and distant failures after external beam radiotherapy for prostate cancer: a multi-institutional analysis.Int J Radiat Oncol Biol Phys. 2006; 64: 1140-1150
- The importance of Prostate-specific Antigen (PSA) Nadir and early identification of PSA relapse after 10 years of prostate iodine 125 seed brachytherapy in Edinburgh.Clin Oncol (R Coll Radiol). 2015; 27: 519-526
- Outcomes following iodine-125 monotherapy for localized prostate cancer: the results of Leeds’ 10-year single-center brachytherapy experience.Int J Radiat Oncol Biol Phys. 2010; 76: 50e56
- Natural history of clinically staged low- and intermediate-risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy.Int J Radiat Oncol Biol Phys. 2010; 76: 349e354
- Predicting biochemical tumor control after brachytherapy for clinically localized prostate cancer: the Memorial Sloan-Kettering Cancer Center experience.Brachytherapy. 2012; 11: 245-249
- 12-Year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer.J Urol. 2005; 173: 1562e1566
- A dose-response study for I-125 implants.Int J Radiat Oncol Biol Phys. 1998; 41: 101-108
- Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation.Int J Radiat Oncol Biol Phys. 2007; 67: 327-333
- Long-term results of a phase II trial of ultrasound-guided radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (RTOG 98-05).Int J Radiat Oncol Biol Phys. 2011; 81: 1e7
- Comparison of biochemical relapse-free survival between primary Gleason score 3 and primary Gleason score 4 for biopsy Gleason score 7 prostate cancer.Int J Radiat Oncol Biol Phys. 2009; 73: 1439-1445
- Five year biochemical recurrence free survival for intermediate risk prostate cancer after radical prostatectomy, external beam radiation therapy or permanent seed implantation.Urology. 2010; 76: 1251-1257
- Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long term results from the MRC RT01 randomized controlled trial.Lancet Oncol. 2014; 15: 464-473
- Long-term results of the Dutch randomized prostate cancer trial: impact of dose-escalation on local, biochemical, clinical failure, and survival.Radiother Oncol. 2014; 110: 104-109
- A comparative analysis between low-dose-rate brachytherapy and external beam radiation therapy for low- and intermediate-risk prostate cancer in Asian men.Acta Oncol. 2021; 60 (Oct): 1291-1295https://doi.org/10.1080/0284186X.2021.1950921
- Initial report of NRG Oncology/RTOG 0232: a phase III study comparing combined external beam radiation and transperineal interstitial permanent brachytherapy with brachytherapy alone for selected patients with intermediate-risk prostatic carcinoma.Int. J Radiat Oncol Biol Phys. 2016; 96: S4
- Comparison of tumor control and toxicity outcomes of high-dose intensity-modulated radiotherapy and brachytherapy for patients with favorable risk prostate cancer.Urology. 2011; 77: 986-990
- Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (the ASCENDE-RT trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate cancer.Int J Radiat Oncol Biol Phys. 2017; 98: 275-285
- Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomized controlled trial.Lancet Oncol. 2007; 8: 475-487
- Effect of standard vs. dose-escalated radiation therapy for patients with intermediate-risk prostate cancer: The NRG Oncology RTOG 0126 Randomized Clinical Trial.JAMA Oncol. 2018; 4e180039https://doi.org/10.1001/jamaoncol.2018.0039
- Comparison of tumor control and toxicity outcomes of high-dose intensity-modulated radiotherapy and brachytherapy for patients with favorable risk prostate cancer.Urology. 2011; 77: 986e990
- Primary Gleason pattern does not impact survival after permanent interstitial brachytherapy for Gleason score 7 prostate cancer.Cancer. 2007; 110: 289-296
- High-intensity focused ultrasound and cryotherapy as salvage treatment in local radio-recurrent prostate cancer.Urol Int. 2012; 89: 373-379
- Interstitial high-dose-rate brachytherapy as salvage treatment for locally recurrent prostate cancer after definitive radiation therapy: Toxicity and 5-year outcome.Brachytherapy. 2017; 16 (Doi:): 186-192https://doi.org/10.1016/j.brachy.2016.09.008
- Adverse effects of androgen deprivation therapy: defining the problem and promoting health among men with prostate cancer.J Natl Compr Canc Netw. 2010; 8: 211-223
Published online: December 20, 2022
Accepted: September 23, 2022
Received in revised form: September 15, 2022
Received: May 13, 2022
© 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.