Interesting Study on Brachytherapy Boost combined with EBR.

[Don_1213]

Impact of High-Dose Rate and Low-Dose Rate Brachytherapy Boost in Patients Receiving External Beam Radiation Therapy for Prostate Cancer

practiceupdate.com/c/110641...

My read of it is that side effects are more severe when Brachy and EBR are combined, It is a new study (December 2019).

[pjoshea13]

from the Conclusion:

"Adding a brachytherapy boost increases the toxicity of radiotherapy in prostate cancer patients in the first five years following treatment. However, our findings also suggest that HDR-BB may improve cancer outcomes compared to EBRT monotherapy. If a brachytherapy boost is considered, HDR-BB is preferable over LDR-BB given its lower rate of GI toxicity. It is still unknown which type of brachytherapy boost is most beneficial in terms of long-term cancer control and a definitive RCT will be required to answer this question."

Not just cancer control, but overall survival.

-Patrick

[oldeyork]

Sorry, I have had no experience of external beams and cannot comment on them.

[Don_1213 in reply to oldeyork]

OK.

[V10fanatic]

I couldn't access the article, but I can tell you that I experienced severe side effects, enough to put me in the ER for a Foley catheter to be installed. I then needed to self -cath for months afterwards.

[Don_1213]

I think the take-home message summarizes it well:

TAKE-HOME MESSAGE

The authors performed an observational cohort study evaluating toxicity and prostate cancer–specific mortality for patients receiving low-dose rate brachytherapy boost, high-dose rate brachytherapy boost, and external beam radiation therapy (EBRT). They found significantly increased gastrointestinal and genitourinary toxicities for both low-dose and high-dose rate brachytherapy boost compared with EBRT. The prostate cancer–specific mortality, however, was lower after high-dose brachytherapy boost compared with EBRT (2.7 vs 3.5%). There was no difference in prostate cancer–specific mortality after low-dose brachytherapy boost compared with EBRT.

Brachytherapy boost is associated with significantly worse gastrointestinal and genitourinary toxicities compared with EBRT. There was no difference in prostate cancer–specific mortality for low-dose brachytherapy boost compared with EBRT.

– Amy N. Luckenbaugh, MD

I believe the inference that could be drawn from this is that low-dose rate brachy has most of the bad side effects of any brachy therapy - and no upside on prostate cancer-specific mortality - when compared to just EBRT alone. Both brachy therapies unfortunately exhibit significantly increased side effects (gastro/genitourinary toxicities) compared to EBRT without brachy.

To me, it brings into question the use of low-dose brachy at all. It offers no survival advantage to EBRT and makes bad side effects likely.

[timotur]

I had HDR-BT with IMRT for Stg-3b+SV+LN. No SE's after 1.5 years, we shall see.

[curtisbirch]

This is why, when I found a doctor who was adamant about monotherapy I went with HDR brachy. So many doctors wanted to treat me with two different treatments whether it was brachy plus EBRT or brachy plus hormones. What made it difficult was depending on which doctor you asked, I was either seen as intermediate risk or intermediate high risk. The latter were worried about a few things they saw on my MRI and were concerned about the quantity of cancer in the biopsy (55-60%). But it was 3 =4 (with a very small percentage of 4). But those doctors who swore by monotherapy could point to studies showing equally effective treatments. So opted to take this leap of faith using less toxicity as my guide.

Ultimately, with monotherapy, there are not only fewer side effects but you can find doctors who have long, successful track records treating with brachy monotherapy (both LDR seeds and HDR).

As someone who was treated at around 50 years old, I was looking for the least amount of toxicity with ED being my biggest concern. So far coming on 3 years, I couldn't be happier both in terms of healing and lack of side effects.