High-dose-rate brachytherapy boost for elderly patients with intermediate to high-risk prostate cancer: 5-year clinical outcome of the PROSTAGE cohort. (July 2022)

• Record Type: Journal Article
• Authors: Marotte, Delphine; Gal, Jocelyn; Schiappa, Renaud; Gautier, Mathieu; Boulahssass, Rabia; Chand-Fouche, Marie-Eve; Hannoun-Levi, Jean-Michel
• Is Part Of: Clinical and translational radiation oncology. Volume 35(2022)
• Page Start: 104
• Page End: 109
• Publication Date: 2022-07
• Subjects: ADT androgen deprivation therapy -- BT brachytherapy -- bRFS biochemical relapse free survival -- CSS cancer specific survival -- CT computerized tomography -- CTCAE common terminology criteria for adverse events -- CTV clinical target volume -- D2cc dose delivered to 2cc of the organ at risk -- D90 dose delivered to 90% of the clinical target volume -- D100 dose delivered to 100% of CTV -- DFS disease-free survival -- DNR dose non-homogeneity ratio -- EBRT external beam radiation therapy -- EQD2 equivalent dose at 2 Gy per fraction -- GI gastro-intestinal -- GU genito-urinary -- HDB high-dose rate brachytherapy -- HR high risk -- IMRT intensity modulated radiation therapy -- IR intermediate risk -- ISUP International Society of Urological Pathology -- LDR low dose-rate -- LR low risk -- lRFS local relapse free survival -- MFU median follow up -- mRFS metastatic relapse-free survival -- MRI magnetic resonance imaging -- NCCN national comprehensive cancer network -- OAR organs at risks -- OS overall survival -- PC prostate cancer -- PET positron emission tomography -- PSA prostate specific antigen -- pts patients -- QoL quality of life -- RCT randomized clinical trial -- rRFS regional lymph-node relapse free survival -- TD total dose -- V100 percentage of the clinical target volume receiving 100% of the prescribed dose -- V150 percentage of the clinical target volume receiving 150% of the prescribed dose -- V200 percentage of the clinical target volume receiving 200% of the prescribed dose -- Vr90 percentage of the rectum volume receiving 90% of the prescribed dose -- Vr100 percentage of the rectum volume receiving 100% of the prescribed dose -- Vu115 percentage of the urethra volume receiving 115% of the prescribed dose -- Vu125 percentage of the urethra volume receiving 125% of the prescribed dose -- 3DRT three-dimensional radiation therapy; Prostate cancer -- High-risk -- Brachytherapy -- Boost -- Eldery -- Comorbidity -- Oncogeriatric assessment; Cancer -- Radiotherapy -- Periodicals; Oncology -- Periodicals; Cancer -- Radiotherapy; Oncology; Radiation Oncology; Neoplasms -- radiotherapy; Translational Medical Research; Periodicals; Electronic journals; Periodicals; 616.9940642
• DOI: 10.1016/j.ctro.2022.05.001
• Languages: English
• ISSNs: 2405-6308

Abstract

Highlights: Intermediate/high risk elderly prostate cancer benefits less from received standards of care. Age is an independent factor for disease control and tolerance. Brachytherapy boost remains efficient and feasible in the elderly. Careful discussion for super elderly patients (>80 y) is warranted. Oncogeriatric assessment is necessary to identify best candidates. Abstract: Purpose: To analyze the oncological outcome in elderly (>70 years) prostate cancer after high-dose rate brachytherapy (HDB) boost. Materials/methods: In this retrospective study, patients with intermediate (IR) and high-risk (HR) prostate cancer underwent external beam radiation therapy (EBRT) followed by HDB boost with/without androgen deprivation therapy (ADT). The impact of age (≤70y vs. > 70y) was investigated. Oncological outcome focused on biochemical relapse-free survival (bRFS), cause-specific (CSS) and overall survival (OS). Late genito-urinary (GU) and gastro-intestinal (GI) toxicities were investigated. Results: From 07/08 to 01/22, 518 pts received a HDB boost, and 380 were analyzed (≤70y:177pts [46.6%] vs. > 70y:203pts [53.4%]). Regarding NCCN classification, 98 pts (≤70y: 53pts; >70y: 45pts; p = 0.107) and 282 pts (≤70y: 124pts; >70y: 158pts; p = NS) were IR and HR pts respectively. Median EBRT dose was 46 Gy [37.5–46] in 23 fractions [14–25]. HDB boost delivered a single fraction of 14/15 Gy (79%). ADT was used in 302 pts (≤70y: 130pts; >70y: 172pts; p = 0.01). With MFU of 72.6 months [67–83] for the whole cohort, 5-y bRFS, 5-y CSS and 5-y OS were 88% [85–92], 99% [97–100] and 94% [92–97] respectively; there was no statistical difference between the two age groups except for 5-y CSS (p = 0.05). Late GU and GI toxicity rates were 32.4% (G ≥ 3 7.3%) and 10.1% (no G3) respectively. Conclusions: For IR and HR prostate cancers, HDB boost leads to high rates of disease control with few late G ≥ 3 GU/GI toxicities. For elderly pts, HDB boost remains warranted mainly in HR pts, while competing comorbidity factors influence OS.