eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
Current Issue Archive Supplements Articles in Press Journal Information Aims and Scope Editorial Office Editorial Board Register as Author Register as Reviewer Instructions for Authors Abstracting and indexing Subscription Advertising Information Links
SCImago Journal & Country Rank

vol. 10
Original paper

Brachytherapy for localized prostate cancer in the modern era: a comparison of patient-reported quality of life outcomes among different techniques

Tiffany M. Morgan, Robert H. Press, Patrick K. Cutrell, Chao Zhang, Zhengja Chen, Sara Rahnema, Martin Sanda, John Pattaras, Pretesh R. Patel, Ashesh B. Jani, Peter J. Rossi

J Contemp Brachytherapy 2018; 10, 6: 495–502
Online publish date: 2018/12/28
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
To report our institutional quality of life (QOL) data for low-dose-rate (LDR) monotherapy (LDR mono), high-dose-rate (HDR) monotherapy (HDR mono), and EBRT with an HDR brachytherapy boost (HDR boost).

Material and methods
The charts of 165 patients with localized adenocarcinoma of the prostate treated with LDR monotherapy (LDR mono), HDR monotherapy (HDR mono), and EBRT with an HDR brachytherapy boost (HDR boost) at a single institution between 2012 and 2015 were reviewed. All patients completed the American Urological Association symptom score (AUASS) and Expanded Prostate Index for Prostate Cancer – Clinical Practice (EPIC-CP) quality of life assessments prior to treatment and at least one follow-up survey. Time points included baseline, ≤ 2 months, 2-≤ 6 months, 6-≤ 12 months, 12-≤ 18 months, 18-≤ 24 months, 24-≤ 30 months, and > 30 months. Linear mixed models were performed to test for significant changes and differences in each outcome over time.

Mean follow-up was 19.5 months. All major functional QOL domains were affected after treatment with brachytherapy for localized prostate cancer. All domains improved over time, with the exception of sexual function scores for all groups and urinary incontinence scores for the HDR mono group. Patients treated with LDR did have higher AUA, irritability/obstructive symptoms, incontinence, bowel, and QOL scores acutely compared to the HDR and HDR + boost groups. Vitality scores were significantly worse in the HDR boost group both acutely and at the > 30-month time point.

Patients receiving HDR brachytherapy had lower acute urinary and rectal toxicity compared to the patients receiving LDR, even when combined with EBRT. However, long-term toxicity was similar.


brachytherapy, quality of life, prostatic neoplasms

Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67: 7-30.
Schröder FH, Hugosson J, Roobol MJ et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360: 1320-1328.
Andriole GL, Crawford ED, Grubb RL 3rd et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009; 360: 1310-1319.
Hamdy FC, Donovan JL, Lane JA et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 2016; 375: 1415-1424.
Sanda MG, Dunn RL, Michalski J et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008; 358: 1250-1261.
Chen RC, Basak R, Meyer AM et al. Association between choice of radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance and patient-reported quality of life among men with localized prostate cancer. JAMA 2017; 317: 1141-1150.
Kuban DA, Tucker SL, Dong L et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008; 70: 67-74.
Zietman AL, Bae K, Slater JD et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/American college of radiology 95-09. J Clin Oncol 2010; 28: 1106-1111.
Dearnaley DP, Sydes MR, Graham JD et al. Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol 2007; 8: 475-487.
Peeters ST, Heemsbergen WD, Koper PC et al. Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol 2006; 24: 1990-1996.
Beckendorf V, Guerif S, Le Prisé E et al. 70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial. Int J Radiat Oncol Biol Phys 2011; 80: 1056-1063.
Viani GA, Stefano EJ, Afonso SL. Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys 2009; 74: 1405-1418.
Meier RM, Bloch DA, Cotrutz C et al. Multicenter trial of stereotactic body radiation therapy for low- and intermediate-risk prostate cancer: survival and toxicity endpoints. Int J Radiat Oncol Biol Phys 2018; 102: 296-303.
Kotecha R, Djemil T, Tendulkar RD et al. Dose-escalated stereotactic body radiation therapy for patients with intermediate- and high-risk prostate cancer: initial dosimetry analysis and patient outcomes. Int J Radiat Oncol Biol Phys 2016; 116: 960-964.
Katz A, Formenti SC, Kang J. Predicting biochemical disease-free survival after prostate stereotactic body radiotherapy: risk-stratification and patterns of failure. Front Oncol 2016; 6: 168.
Grills IS, Martinez AA, Hollander M et al. High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds. J Urol 2004; 171: 1098-1104.
Tward JD, Jarosek S, Chu H et al. Time course and accumulated risk of severe urinary adverse events after high- versus low-dose-rate prostate brachytherapy with or without external beam radiation therapy. Int J Radiat Oncol Biol Phys 2016; 95: 1443-1453.
Chao M, Spencer S, Guerrieri M et al. A single institution analysis of low-dose-rate brachytherapy: 5-year reported survival and late toxicity outcomes. J Contemp Brachytherapy 2018; 10: 155-161.
Morris WJ, Tyldesley S, Rodda S et al. Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (the ASCENDE-RT Trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys 2017; 98: 275-285.
Grimm P, Billiet I, Bostwick D et al. Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group. BJU Int 2012; 109 (Suppl 1): 22-29.
Merrick GS, Tennant A, Wallner KE et al. Does supplemental external beam radiation therapy impact urinary, bowel, and erectile function following permanent prostate brachytherapy? Results of two prospective randomized trials. J Contemp Brachytherapy 2017; 9: 403-409.
Morgan TM, Press RH, Cutrell PK et al. Hypofractionated external beam radiation therapy in combination with HDR boost for localized prostate cancer: patient reported quality of life outcomes. J Contemp Brachytherapy 2018; 10: 211-217.
Barry MJ, Fowler FJ, Jr., O’Leary MP et al. The American Urological Association Symptom Index for benign prostatic hyperplasia. J Urol 2017; 197: S189-S197.
Chang P, Szymanski KM, Dunn RL et al. Expanded prostate cancer index composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer. J Urol 2011; 186: 865-872.
Morton G, Loblaw A, Cheung P et al. Is single fraction 15 Gy the preferred high dose-rate brachytherapy boost dose for prostate cancer? Radiother Oncol 2011; 100: 463-467.
Helou J, D’Alimonte L, Loblaw A et al. High dose-rate brachytherapy boost for intermediate risk prostate cancer: Long-term outcomes of two different treatment schedules and early biochemical predictors of success. Radiother Oncol 2015; 115: 84-89.
Falk AT, Demontoy S, Chamorey E et al. High-dose-rate brachytherapy boost for prostate cancer: Comparison of three different fractionation schemes. Brachytherapy 2017; 6: 993-999.
Vigneault E, Mbodji K, Magnan S et al. High-dose-rate brachytherapy boost for prostate cancer treatment: Different combinations of hypofractionated regimens and clinical outcomes. Radiother Oncol 2017; 124: 49-55.
Morton G, Chung HT, McGuffin M et al. Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: Early toxicity and quality-of life results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy. Radiother Oncol 2017; 122: 87-92.
Jawad MS, Dilworth JT, Gustafson GS et al. Outcomes associated with 3 treatment schedules of high-dose-rate brachytherapy monotherapy for favorable-risk prostate cancer. Int J Radiat Oncol Biol Phys 2016; 94: 657-666.
Yoshioka Y, Suzuki O, Isohashi F et al. High-dose-rate brachytherapy as monotherapy for intermediate- and high-risk prostate cancer: clinical results for a median 8-year follow-up. Int J Radiat Oncol Biol Phys 2016; 94: 675-682.
Hauswald H, Kamrava MR, Fallon JM et al. High-dose-rate monotherapy for localized prostate cancer: 10-year results. Int J Radiat Oncol Biol Phys 2016; 94: 667-674.
Wallner K, Roy J, Harrison L. Dosimetry guidelines to minimize urethral and rectal morbidity following transperineal I-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys 1995; 32: 465-471.
Zelefsky MJ, Hollister T, Raben A et al. Five-year biochemical outcome and toxicity with transperineal CT-planned permanent I-125 prostate implantation for patients with localized prostate cancer. Int J Radiat Oncol Biol Phys 2000; 47: 1261-1266.
Beyer DC, Priestley JB, Jr. Biochemical disease-free survival following 125I prostate implantation. Int J Radiat Oncol Biol Phys 1997; 37: 559-563.
Moinpour CM, Hayden KA, Unger JM et al. Health-related quality of life results in pathologic stage C prostate cancer from a Southwest Oncology Group trial comparing radical prostatectomy alone with radical prostatectomy plus radiation therapy. J Clin Oncol 2008; 26: 112-120.
Hoskin P, Rojas A, Ostler P et al. Single-dose high-dose-rate brachytherapy compared to two and three fractions for locally advanced prostate cancer. Radiother Oncol 2017; 124: 56-60.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe