High-dose-rate brachytherapy boost for prostate cancer treatment: Different combinations of hypofractionated regimens and clinical outcomes. Issue 1 (July 2017)

• Record Type: Journal Article
• Authors: Vigneault, Eric; Mbodji, Khaly; Magnan, Sindy; Després, Philippe; Lavallée, Marie-Claude; Aubin, Sylviane; Beaulieu, Luc; Foster, William; Martin, André-Guy
• Is Part Of: Radiotherapy and oncology. Volume 124:Issue 1(2017:Jul.)
• Page Start: 49
• Page End: 55
• Publication Date: 2017-07
• Subjects: Prostate cancer -- HDR brachytherapy -- Biologically effective dose -- PSA failure; 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.2017.06.012
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Purpose: To report the outcomes of our high-dose-rate brachytherapy (HDR-BT) boost experience in localized prostate cancer treated with different combinations of radiation doses and fractionation. Material and methods: Between 1999 and 2011, 832 patients were treated with different regimens of external beam radiotherapy (EBRT) and HDR-BT. These regimens were converted into three biologically effective dose (BED) groups. The biochemical failure-free survival (BFFS), reported with the phoenix definition and prostate-specific antigen (PSA) >0.2 ng/ml at 5-year, genitourinary (GU) and gastrointestinal (GI) toxicities were compared between the groups. Results: The 5-, 10-year BFFS for the entire cohort were 94.6% and 92.5%, for overall survival (OS) 96.1% and 80.3% and for prostate cancer-specific survival (PCSS) 99.5% and 97.8%. The percentage of patients with a 5-year PSA level <0.2 ng/ml was 68.6%, 78.7% and 86.7% in the BED group of <250, 250–260 and >260 Gy ( p = 0.005) while the 5-year BFFS rates according to phoenix definition were 97.3%, 94.3% and 94.9% for BED group <250, 250–260 and >260 Gy ( p = 0.453). On multivariate logistic regression, patients in the BED > 260 Gy group were significantly more likely to remain free from 5-year PSA values ≥0.2 ng/mL compared with those in the BED < 250 Gy group (OR: 0.350, p = 0.011). Grade ≥ 3 acute GU toxicity was reported in 2 patients (4.7%) for BED > 260 Gy while grade ≥ 3 late GU toxicity was reported in 6 (1.7%) and 9 (4.9%) patients for 250–260 Gy and >260 Gy BED groups. Conclusions: The increase in BED with the hypofractionated regimens correlates with an improvement in biochemical control with of urinary toxicity. This increase in urinary toxicity is small and clinically acceptable.