eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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SCImago Journal & Country Rank

6/2020
vol. 12
 
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abstract:
Original paper

High-dose-rate brachytherapy as monotherapy for localized prostate cancer using three different doses – 14 years of single-centre experience

Carlo Pietro Soatti
1
,
Durim Delishaj
1
,
Romerai D’Amico
1
,
Cristina Frigerio
2
,
Ilaria Costanza Fumagalli
3
,
Francesco Bonsignore
2
,
Giulia Sangalli
2
,
Fausto Declich
2
,
Stefano Arcangeli
3
,
Antonio Ardizzoia
4
,
Alessandro Colombo
1

1.
Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy
2.
Medical Physics Unit, Alessandro Manzoni Hospital, Lecco, Italy
3.
Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan “Bicocca”, Milan, Italy
4.
Department of Oncology, Alessandro Manzoni Hospital, Lecco, Italy
J Contemp Brachytherapy 2020; 12, 6: 533–539
Online publish date: 2020/12/18
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Purpose
To evaluate clinical outcomes in patients with localized prostate cancer (LPC) treated with 3D conformal high-dose-rate (HDR) brachytherapy (BT) as monotherapy.

Material and methods
From March 2004 to November 2017, 277 men with LPC underwent 3D conformal HDR-BT as monotherapy, with a temporary implant. The dose prescription was: 38 Gy in 4 fractions (149 patients), 27 Gy in 2 fractions (41 patients), and 19-20 Gy in a single fraction (87 patients). Biochemical progression-free survival (bPFS), progression-free survival (PFS), and cancer-specific survival (CSS) were calculated. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicity assessment were performed using Common Terminology Criteria for Adverse Events v5.0.

Results
The mean age was 67 (range, 47-81) years. Overall, 145 patients were low-risk, 116 intermediate-risk, and 16 high-risk prostate cancer. After a median follow-up of six years (range, 6-160 months), bPFS, PFS, and CSS were 81%, 96%, and 97%, respectively. Dose prescription, initial prostate specific antigen (iPSA)  9,5 ng/ml, and high-risk disease resulted in prognostic factors regarding bPFS. Only G2-G3 acute or late GI and GU toxicities were observed.

Conclusions
HDR-BT as monotherapy is a valid and safe treatment modality for localized prostate cancer. After a long follow-up, patients receiving 19-20 Gy in a single fraction had a lower biochemical control rate compared to patients receiving 38 Gy in 4 fractions or 27 Gy in 2 fractions. Randomized prospective trials with a longer follow-up are necessary to confirm our results, and define total doses and dose per fraction for HDR-BT in patients with LPC.

keywords:

high-dose-rate, brachytherapy, prostate cancer, prostate-specific antigen, PSA

 
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