Abstract
PURPOSE
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.
RESULTS
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.
CONCLUSION
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.
Keywords
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Article info
Publication history
Published online: December 20, 2022
Accepted:
September 23,
2022
Received in revised form:
September 15,
2022
Received:
May 13,
2022
Identification
Copyright
© 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
