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Interstitial hyperthermia of the prostate in combination with brachytherapy

An evaluation of feasibility and early tolerance

Interstitielle Hyperthermie der Prostata in Kombination mit Brachytherapie

Eine Bewertung von Realisierbarkeit und früher Toleranz

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Abstract

Objective

A retrospective study to evaluate the feasibility and toxicity of interstitial hyperthermia (IHT) combined with high-dose-rate (HDR) brachytherapy as the initial treatment for low- and intermediate-risk prostate cancer, and as a salvage therapy in previously irradiated patients with local recurrence.

Patients and methods

Between 18 December 2008 and 5 September 2012, 73  prostate cancer patients were treated with interstitial HDR brachytherapy of the prostate combined with IHT. In 54 patients this was the initial therapy for prostate cancer, while the other 19 were treated for local recurrence after previously undergoing external beam radiotherapy (EBRT). Toxicity for the organs of the genitourinary system and rectum was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v. 4.03 within 3 months after treatment.

Results

Median follow-up was 15 months (range 3–46). The combination of HDR brachytherapy and IHT was well tolerated. The toxicity profile was similar to that of HDR brachytherapy when not combined with hyperthermia. The most common minor complications were urinary frequency (grade 1: 37 %; grade 2: 22 %), nocturia (three times per night: 29 %; four- or more times per night: 20 %) and transient weakening of the urine stream (grade 1: 36 %; grade 2: 11 %). No early rectal complications were observed in the patient group and the severity of genitourinary toxicity was only grade 1–2.

Conclusion

Early tolerance of IHT in combination with HDR brachytherapy is good. Further prospective clinical studies should focus on the effects of combining IHT with HDR brachytherapy and the influence of this adjuvant therapy on biochemical disease-free survival, local control and overall survival.

Zusammenfassung

Ziel

Die vorliegende retrospektive Studie bewertet die Realisierbarkeit und Toxizität der interstitiellen Hyperthermie verbunden mit der „High-dose-rate“-(HDR-)Brachytherapie, sowohl bei Kranken, die ursprünglich wegen Prostatakrebs (aus der Gruppe mit niedrigem und mittlerem Risiko) behandelt wurden, als auch bei vorher bestrahlten Kranken, bei denen es zu einem Lokalrezidiv gekommen war.

Patienten und Methoden

Im Zeitraum vom 18. Dezember 2008 bis zum 5. September 2012 wurden am Institut für Onkologie in Krakau 73 Patienten mit der Diagnose Prostatakrebs einer interstitiellen HDR-Brachytherapie der Prostata in Verbindung mit einer interstitiellen Hyperthermie unterzogen. Insgesamt 54 Patienten wurden wegen eines Primärtumors der Prostata und 19 Patienten wegen eines Lokalrezidivs nach vorheriger externer Bestrahlung („external beam radiotherapy“, EBRT) behandelt. Die Toxizität für die Harn- und Geschlechtsorgane wurde laut des Protokolls „Common Terminology Criteria for Adverse Events“ v 4.03 (CTCAE) innerhalb von 3 Monaten nach Behandlung bewertet.

Ergebnisse

Das mediane Follow-up betrug 15 Monate (3–46 Monate). Die Verbindung der HDR-Brachytherapie mit der interstitiellen Hyperthermie wurde gut vertragen. Das Toxizitätsprofil war ähnlich wie bei der Behandlung ohne Hyperthermie als adjuvante Therapie. Die häufigsten milden Komplikationen waren Pollakisurie (Grad 1:37 %, Grad 2: 22 %), Nykturie (3-mal pro Nacht: 29 %, 4-mal und mehr pro Nacht: 20 %) und eine vorübergehende Schwächung des Harnstrahls (Grad 1: 36 %, Grad 2: 11 %). Bei den beobachteten Patienten wurden keine frühen Komplikationen seitens des Mastdarms festgestellt und die Toxizität gegen die Harn- und Geschlechtsorgane betrug nur Grad 1 oder 2.

Schlussfolgerungen

Die frühe Toleranz der interstitiellen Hyperthermie mit adjuvanter HDR-Brachytherapie der Prostata ist gut. Weitere prospektive klinische Studien sollten die Effekte der Verbindung der interstitiellen Hyperthermie mit der HDR-Brachytherapie und den Einfluss dieser adjuvanten Therapie auf das Überleben ohne biochemische Rezidive, die lokale Kontrolle und die Gesamtüberlebensraten untersuchen.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiotherapy, Centre of Oncology, M. Skłodowska Curie Institute, Krakow Branch, ul. Garncarska 11, 31-115, Krakow, Poland

    A.M. Kukiełka M.D., M. Hetnał M.D., P. Brandys M.D., T. Walasek M.D., T. Dąbrowski M.D. & E. Pluta M.D.

  2. Department of Medical Physics, Department of Radiotherapy, Centre of Oncology, M. Skłodowska Curie Institute, Krakow Branch, Krakow, Poland

    D. Nahajowski & R. Kudzia

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  1. A.M. Kukiełka M.D.
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Correspondence to A.M. Kukiełka M.D..

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Kukiełka, A., Hetnał, M., Brandys, P. et al. Interstitial hyperthermia of the prostate in combination with brachytherapy. Strahlenther Onkol 189, 467–475 (2013). https://doi.org/10.1007/s00066-013-0321-6

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  • DOI: https://doi.org/10.1007/s00066-013-0321-6

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