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
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 PSA3y 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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