Dose escalation to dominant intraprostatic lesions with MRI-transrectal ultrasound fusion High-Dose-Rate prostate brachytherapy. Prospective phase II trial. Issue 1 (April 2016)

• Record Type: Journal Article
• Authors: Gomez-Iturriaga, Alfonso; Casquero, Francisco; Urresola, Arantza; Ezquerro, Ana; Lopez, Jose I.; Espinosa, Jose M.; Minguez, Pablo; Llarena, Roberto; Irasarri, Ana; Bilbao, Pedro; Crook, Juanita
• Is Part Of: Radiotherapy and oncology. Volume 119:Issue 1(2016:Apr.)
• Page Start: 91
• Page End: 96
• Publication Date: 2016-04
• Subjects: Prostate cancer -- Dominant intraprostatic lesion -- Dose escalation -- High-Dose-Rate brachytherapy; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2016.02.004
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Background and purpose: To demonstrate the feasibility, safety and effectiveness of dose escalation to intraprostatic lesions with MRI-transrectal ultrasound fusion High-Dose-Rate (HDR) brachytherapy. Materials and methods: 15 patients with intermediate-high risk prostate cancer and visible dominant intra-prostatic nodule on mpMRI have been treated. The treatment consisted of combined MRI-TRUS fusion HDR-brachytherapy (1 fraction of 1500 cGy) and hypofractionated external beam (3750 cGy in 15 fractions). A dose of 1875 Gy was delivered to at least 98% of the DIL volume. Results: Median prostate volume was 23.8 cc; median number of needles was 16 (13–18). Dose escalation to DIL was feasible in 14/15 patients (93%) without violating dosimetric constraints and 1 patient presented a minimal deviation of dosimetric restrictions. With a median follow-up of 18 months (17–24), none of the patients developed acute urinary retention or grade ⩾3 toxicity. In addition to standard PSA follow-up, response has been assessed by mpMRI at 12 months. All patients presented adequate morphological responses on anatomical and functional sequences. Conclusions: HDR brachytherapy using MRI-transrectal ultrasound fusion for image guidance is a suitable technique for partial prostate dose escalation. Tolerance and toxicity profiles are excellent and results are encouraging in terms of biochemical, morphological and functional response.