eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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2/2020
vol. 12
 
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abstract:
Original paper

A radiobiological study of the schemes with a low number of fractions in high-dose-rate brachytherapy as monotherapy for prostate cancer

Damián Guirado
1, 2, 3
,
Samuel Ruiz-Arrebola
4
,
Ana M. Tornero-López
5
,
Jose M. de la Vega
1, 2
,
Pedro J. Prada
4
,
Antonio M. Lallena
2, 6

1.
Unidad de Radiofísica, Hospital Universitario Clínico “San Cecilio”, E-18016 Granada, Spain
2.
Instituto de Investigación Biosanitaria (ibs. GRANADA), Complejo Hospitalario Universitario de Granada/Universidad de Granada, Granada, Spain
3.
CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
4.
Servicio de Oncología Radioterápica, Hospital Universitario “Marqués de Valdecilla”, Santander, Spain
5.
Servicio de Radiofísica y Protección Radiológica, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
6.
Departamento de Física Atómica, Molecular y Nuclear, Universidad de Granada, Granada, Spain
J Contemp Brachytherapy 2020; 12, 2: 193–200
Online publish date: 2020/04/18
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Purpose
Schemes with high doses per fraction and small number of fractions are commonly used in high-dose-rate brachytherapy (HDR-BT) for prostate cancer. Our aim was to analyze the differences between published clinical results and the predictions of radiobiological models for absorbed dose required in a single fraction monotherapy HDR-BT.

Material and methods
Published HDR-BT clinical results for low- and intermediate-risk patients with prostate cancer were revised. For 13 clinical studies with 16 fractionation schedules between 1 and 9 fractions, a dose-response relation in terms of the biochemical control probability (BC) was established using Monte Carlo-based statistical methods.

Results
We obtained a value of / = 22.8 Gy (15.1-60.2 Gy) (95% CI) much larger than the values in the range 1.5-3.0 Gy that are usually considered to compare the results of different fractionation schemes in prostate cancer radiotherapy using doses per fraction below 6 Gy. The doses in a single fraction producing BC = 90% and 95% were 22.3 Gy (21.5-24.2 Gy) and 24.3 Gy (23.0-27.9 Gy), respectively.

Conclusions
The / obtained in our analysis of 22.8 Gy for a range of dose per fraction between 6 and 20.5 Gy was much greater than the one currently estimated for prostate cancer using low doses per fraction. This high value of / explains reasonably well the data available in the region of high doses per fraction considered.

keywords:

HDR brachytherapy, prostate cancer, monotherapy

 
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