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High-dose-rate interstitial brachytherapy in combination with androgen deprivation therapy for prostate cancer

Are high-risk patients good candidates?

Hochdosierte interstitielle Brachytherapie in Kombination mit einer Androgendeprivationstherapie beim Prostatakarzinom

Sind Hochrisiko-Patienten gute Kandidaten?

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Abstract

Background and purpose

To evaluate the effectiveness of high-dose-rate interstitial brachytherapy (HDR-ISBT) as the only form of radiotherapy for high-risk prostate cancer patients.

Patients and methods

Between July 2003 and June 2008, we retrospectively evaluated the outcomes of 48 high-risk patients who had undergone HDR-ISBT at the National Hospital Organization Osaka National Hospital. Risk group classification was according to the criteria described in the National Comprehensive Cancer Network (NCCN) guidelines. Median follow-up was 73 months (range 12–109 months). Neoadjuvant androgen deprivation therapy (ADT) was administered to all 48 patients; 12 patients also received adjuvant ADT. Maximal androgen blockade was performed in 37 patients. Median total treatment duration was 8 months (range 3–45 months). The planned prescribed dose was 54 Gy in 9 fractions over 5 days for the first 13 patients and 49 Gy in 7 fractions over 4 days for 34 patients. Only one patient who was over 80 years old received 38 Gy in 4 fractions over 3 days. The clinical target volume (CTV) was calculated for the prostate gland and the medial side of the seminal vesicles. A 10-mm cranial margin was added to the CTV to create the planning target volume (PTV).

Results

The 5-year overall survival and biochemical control rates were 98 and 87 %, respectively. Grade 3 late genitourinary and gastrointestinal complications occurred in 2 patients (4 %) and 1 patient (2 %), respectively; grade 2 late genitourinary and gastrointestinal complications occurred in 5  patients (10 %) and 1 patient (2 %), respectively.

Conclusion

Even for high-risk patients, HDR-ISBT as the only form of radiotherapy combined with ADT achieved promising biochemical control results, with acceptable late genitourinary and gastrointestinal complication rates.

Zusammenfassung

Hintergrund und Zweck

Beurteilung der Wirksamkeit von interstitieller Brachytherapie mit Hochdosisraten („high-dose-rate interstitial brachytherapy“, HDR-ISBT) als einzige Form der Radiotherapie für Hochrisiko-Prostatakarzinompatienten.

Patienten und Methodik

Zwischen Juli 2003 und Juni 2008 werteten wir retrospektiv die Ergebnisse von 48 Patienten mit hohem Risiko aus, die im National Hospital Organization Osaka National Hospital mittels HDR-ISBT behandelt worden waren. Die Klassifikation der Risikogruppen wurde gemäß der Richtlinien des „National Comprehensive Cancer Network“ (NCCN) durchgeführt. Die mittlere Nachbeobachtungszeit betrug 73 Monate (Bereich 12–109 Monate). Eine neoadjuvante Androgendeprivationstherapie (ADT) erhielten alle 48 Patienten, darunter 12 Patienten zusätzlich als adjuvante Behandlung. Einer maximalen Androgenblockade unterzogen sich 37 Patienten. Die Gesamtbehandlungszeit umfasste im Mittel 8 Monate (Bereich 3–45 Monate). Die geplante vorgeschriebene Dosis betrug bei den ersten 13 Patienten 54 Gy in 9 Fraktionen über 5 Tage bzw. bei den anderen 34 Patienten 49 Gy in 7 Fraktionen über 4 Tage. Nur ein einziger Patient im Alter von über 80 Jahren erhielt eine Dosis von 38 Gy in 4 Fraktionen über 3 Tage. Das klinische Zielvolumen (CTV) wurde für die Prostatadrüse und die mediale Seite der Samenblase (SV) berechnet. Ein 10 mm breiter kranialer Rand wurde dem CTV als Planzielvolumen (PTV) hinzugefügt.

Ergebnisse

Die Gesamtüberlebensrate und die biochemische Kontrollrate über 5 Jahre betrug 98 bzw. 87 %. Späte Grad-3-Urogenital- und -Gastrointestinalkomplikationen traten bei 2 bzw. 1 Patienten (4 bzw. 2 %) auf, während späte Grad-2-Urogenital- und -Gastrointestinalkomplikationen bei 5 bzw. 1 Patienten (10 bzw. 2 %) festgestellt wurden.

Schlussfolgerung

Auch bei Hochrisiko-Patienten erzielte die HDR-ISBT als alleinige Form der Radiotherapie in Kombination mit ADT vielversprechende biochemische Kontrollergebnisse mit akzeptablen späten urogenitalen und gastrointestinalen Komplikationsraten.

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Conflict of interest

K. Yoshida, H. Yamazaki, T. Takenaka, T. Kotsuma, M. Yoshida, K. Masui, Y. Yoshioka, Y. Narumi, T. Oka and E. Tanaka state that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiology, Osaka Medical College, 2–7, Daigaku-machi, 569-8686, Takatsuki, Osaka, Japan

    Ken Yoshida M.D. & Yoshifumi Narumi M.D.

  2. Department of Radiology, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan

    Hideya Yamazaki M.D. & Koji Masui M.D.

  3. Department of Radiology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, 540-0006, Osaka city, Osaka, Japan

    Tadashi Takenaka R.T.T

  4. Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, 540-0006, Osaka city, Osaka, Japan

    Tadayuki Kotsuma M.D., Mineo Yoshida M.D. & Eiichi Tanaka M.D.

  5. Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, 565-0871, Suita, Osaka, Japan

    Yasuo Yoshioka M.D.

  6. Department of Urology, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, 540-0006, Osaka city, Osaka, Japan

    Toshitsugu Oka M.D.

Authors
  1. Ken Yoshida M.D.
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  2. Hideya Yamazaki M.D.
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  3. Tadashi Takenaka R.T.T
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  4. Tadayuki Kotsuma M.D.
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  5. Mineo Yoshida M.D.
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  6. Koji Masui M.D.
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  7. Yasuo Yoshioka M.D.
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  8. Yoshifumi Narumi M.D.
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  9. Toshitsugu Oka M.D.
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  10. Eiichi Tanaka M.D.
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Corresponding author

Correspondence to Ken Yoshida M.D..

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Yoshida, K., Yamazaki, H., Takenaka, T. et al. High-dose-rate interstitial brachytherapy in combination with androgen deprivation therapy for prostate cancer. Strahlenther Onkol 190, 1015–1020 (2014). https://doi.org/10.1007/s00066-014-0675-4

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  • DOI: https://doi.org/10.1007/s00066-014-0675-4

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