High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy.

[pjoshea13]

New Norwegian study.

Of course, it is merely an observational study.

"We investigated 10-year PCa-specific mortality (PCSM) and overall mortality (OM) in high-risk patients treated with HDR-BT/EBRT (calculated EQD2 = 102 Gy) compared to EBRT alone (70 Gy)."

"Men with high-risk PCa have a significantly reduced PCSM and OM rates when treated with dose-escalated radiotherapy achieved by HDR-BT/EBRT compared to EBRT alone (70 Gy)"

"The combined HDR-BT/EBRT treatment was found to give a 3.6-fold decrease in Prostate Cancer Specific Mortality (PCSM) and a 1.6-fold decrease in Overall Mortality (OM). Gleason score and type of treatment strongly influenced PCSM whereas only treatment modality was associated with OM."

-Patrick

ncbi.nlm.nih.gov/pubmed/303...

Radiother Oncol. 2018 Oct 30. pii: S0167-8140(18)33537-0. doi: 10.1016/j.radonc.2018.10.013. [Epub ahead of print]

Ten-year survival after High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort.

Wedde TB1, Småstuen MC2, Brabrand S3, Fosså SD4, Kaasa S5, Tafjord G3, Russnes KM6, Hellebust TP7, Lilleby W3.

Author information

1

Department of Oncology, Oslo University Hospital and University of Oslo, Norway. Electronic address: [e-mail].

2

Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Norway. Electronic address: [e-mail].

3

Department of Oncology, Oslo University Hospital, Norway.

4

National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Norway.

5

Department of Oncology, Oslo University Hospital and University of Oslo, Norway.

6

Department of Oncology, Akershus University Hospital, Lørenskog, Norway.

7

Department of Medical Physics, Oslo University Hospital, Norway.

Abstract

BACKGROUND:

The survival benefit of dose-escalation with High-Dose-Rate brachytherapy (HDR-BT) boost combined with External Beam Radiotherapy (EBRT) for the treatment of high-risk prostate cancer (PCa) remains debatable. We investigated 10-year PCa-specific mortality (PCSM) and overall mortality (OM) in high-risk patients treated with HDR-BT/EBRT (calculated EQD2 = 102 Gy) compared to EBRT alone (70 Gy).

METHODS:

HDR-BT boosts (10 Gy × 2) were given 2 weeks apart followed by 50 Gy conformal EBRT (2 Gy × 25) to the prostate and seminal vesicles. The HDR-BT/EBRT group (N:325) received Androgen Deprivation Therapy for a median duration of 2 years. The historical control group (N:296), received a median dose of 70 Gy (2 Gy × 35) to the prostate and seminal vesicles with lifelong Anti-Androgen Treatment. For each treatment group PCSM and OM were established by competing-risk analyses and Kaplan-Meier analyses respectively. Differences were evaluated by the logrank test. Independent associations were established by Cox regression analyses. Significance level set to p < 0.05.

RESULTS:

Median follow-up was 104 and 120 months for the HDR-BT/EBRT and the EBRT group respectively. A 3.6-fold decreased risk of PCSM (p < 0.01) and a 1.6-fold decreased risk of OM (p = 0.02) in the HDR-BT/EBRT cohort compared to the EBRT-only group were revealed. Ten-year OM and PCSM rates were 16% and 2.5% in the HDR-BT/EBRT group versus 23% and 8.2% in the EBRT-only group respectively. Both treatment modality (HR = 3.59, 95%CI 1.50-8.59) and Gleason score (HR = 2.48, 95%CI 1.18-5.21) were associated with PCSM. Only treatment modality (HR = 1.63, 95%CI = 1.08-2.44) was significantly associated with OM.

CONCLUSIONS:

Men with high-risk PCa have a significantly reduced PCSM and OM rates when treated with dose-escalated radiotherapy achieved by HDR-BT/EBRT compared to EBRT alone (70 Gy). A Gleason score of 8-10 was independently associated with increased risk of PCSM. Randomized studies are warranted.

SUMMARY:

Observational study of 10-year survival in high-risk Prostate Cancer (PCa) after High-Dose-Rate brachytherapy combined with External Beam Radiation Therapy (HDR-BT/EBRT) compared to EBRT alone. The combined HDR-BT/EBRT treatment was found to give a 3.6-fold decrease in Prostate Cancer Specific Mortality (PCSM) and a 1.6-fold decrease in Overall Mortality (OM). Gleason score and type of treatment strongly influenced PCSM whereas only treatment modality was associated with OM. The observed benefits of dose-escalation warrant future randomized trials.

Copyright © 2018 Elsevier B.V. All rights reserved.

KEYWORDS:

Brachytherapy versus external beam radiation treatment; HDR-brachytherapy; High-risk; Overall mortality; Prostate cancer; Prostate-cancer-specific mortality

PMID: 30389241 DOI: 10.1016/j.radonc.2018.10.013

[cesanon]

This is the standard Datolli Clinic treatment protocol.

[AlanMeyer]

I had HDR_BT + EBRT + Lupron (4 months) in 2003 for a G 4+3 cancer and I'm still here, apparently (knock on wood) cancer free. I lucked out.

I wonder how this compares to the modern SBRT protocols.

Alan

[Hidden in reply to AlanMeyer]

Was it spread to lymph nodes, or seminal vesicle or bones?

[AlanMeyer in reply to Hidden]

To the best of my knowledge it had not spread outside the prostate bed. At the time that I had the treatment I knew squat about prostate cancer and didn't know to ask the right questions.

Alan

[VHRguy]

Just an observation - 70 Gy EBRT is well below current dose-escalated protocols of 79.2 Gy or a little more possible by IGRT. It would be interesting to see a similar comparison with more contemporary protocols.

[Hidden]

My urologist disparaged brachytherapy -- maybe because it wasn't in the bag of tricks of the radiation treatment center he was affiliated with, which offered only external beam? It is tough dealing with PC -- the burden is on you to make good decisions at a time when you are still in shock and not well informed on the treatment options. At that time I was also on an insurance plan that limited me to in-network providers and also requiring a referral -- I couldn't go where ever I wanted unless I paid out of pocket.