High dose-rate brachytherapy boost for intermediate risk prostate cancer: Long-term outcomes of two different treatment schedules and early biochemical predictors of success

doi:10.1016/j.radonc.2015.02.023

Radiotherapy and Oncology

Volume 115, Issue 1, April 2015, Pages 84-89

https://doi.org/10.1016/j.radonc.2015.02.023 Get rights and content

Abstract

Background and purpose

To report long-term cancer control rates following high dose-rate (HDR) brachytherapy boost for intermediate risk prostate cancer and explore early biochemical predictors of success.

Material and methods

Results of two sequential phase II trials are updated and compared: (1) Single 15 Gy HDR-boost followed by external beam radiotherapy (EBRT) 37.5 Gy/15fractions, (2) Two HDR fractions of 10 Gy followed by EBRT 45 Gy/25fractions. Patients were followed prospectively for clinical and biochemical outcomes. Nadir PSA (nPSA) and PSA at 3-years were analyzed as continuous variables, and ROC analysis was used to identify the optimal cutoff values. Kaplan–Meier bDFS curves were generated and the log-rank test used to compare different groups

Results

183 patients were accrued; 123 to the single fraction trial and 60 to the standard fractionation trial, with a median follow-up of 74 months and 99 months, respectively. The 5-year biochemical relapse-free survival was 97.4% and 92.7%, respectively (p = 0.995). Median nPSA was 0.08 ng/ml. Failure to achieve a nPSA <0.4 ng/ml was associated with a significantly higher rate of biochemical relapse (5-year bDFS: 100% vs. 72%; p < 0.0001).

Conclusion

HDR boost with single fraction 15 Gy provides durable long-term biochemical disease-free survival. PSA nadir <0.4 ng/ml is associated with very low risk of biochemical failure.

Section snippets

Patient selection and treatment overview

Patients participated in two prospective phase II clinical trials of HDR boost conducted sequentially and approved by our local Research Ethics board; the first consisted of two separate HDR fractions of 10 Gy delivered 1 week apart and followed by EBRT to a total dose of 45 Gy in 25 fractions delivered over 5 weeks (Standard Fractionation) and the second of a single HDR fraction of 15 Gy followed by 37.5 Gy EBRT in 15 fractions delivered over 3 weeks (HDR Single). The patient selection, study design

Results

Overall 183 patients were accrued; 123 to the single fraction trial and 60 patients to the standard fractionation trial. As previously described, median age was 67 years; 59% had stage T1c, 41% Stage T2; 89% Gleason 7 and 11% Gleason 6; and median baseline PSA was 6.8 ng/mL (1.2–17.9 ng/mL). Median follow-up for the entire group was 74 months (interquartile range [IQR], 61.9–88.3); 73 months (IQR, 62.9–84.6) and 99 months (IQR, 58.3–110.2) respectively for the single and standard fractionation

Discussion

With a median follow-up of 74 months, this analysis is consistent with a lack of difference in biochemical failure between an HDR boost dose of 15 Gy as a single fraction and 20 Gy given in two fractions. Both the single fraction protocol and the standard fractionated protocol are associated with high bDFS. Our biochemical disease-control rates are comparable to those reported by other mature series with a median follow-up between 5 and 9 years and disease-free survival probabilities of over 85–90%

Conclusion

HDR boost with single fraction 15 Gy provides durable long-term biochemical disease-free survival. Patients who achieved a PSA < 0.6 ng/ml at 3 years or a nadir PSA < 0.4 ng/ml at any time point were very unlikely to develop subsequent biochemical failure.

Our findings are in line with the data from other studies of PSA kinetics following LDR-BT, suggesting that nPSA is an important post-treatment prognostic factor. nPSA and PSA_3y can serve to identify patients at higher risk of recurrence and maybe

Conflict of interest statement

The authors have no personal or financial conflict with work presented in this manuscript.

Acknowledgments

This work was supported by an ACURA award from the Canadian Association of Radiation Oncologists, and by an award from the Motorcycle Ride for Dad.

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Prostate cancer brachytherapyHigh dose-rate brachytherapy boost for intermediate risk prostate cancer: Long-term outcomes of two different treatment schedules and early biochemical predictors of success

Abstract

Background and purpose

Material and methods

Results

Conclusion

Section snippets

Patient selection and treatment overview

Results

Discussion

Conclusion

Conflict of interest statement

Acknowledgments

Eur Urol

Brachytherapy

Brachytherapy

Radiother Oncol

Brachytherapy

Radiother Oncol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Radiother Oncol

Int J Radiat Oncol Biol Phys

Radiother Oncol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Urology

Radiother Oncol

Int J Radiat Oncol Biol Phys

Prostate cancer brachytherapy
High dose-rate brachytherapy boost for intermediate risk prostate cancer: Long-term outcomes of two different treatment schedules and early biochemical predictors of success