Skip to main content

Permanent and High Dose Rate Brachytherapy (Technique, Indications, Results, Morbidity)

  • Chapter
  • First Online:
Management of Prostate Cancer

Abstract

Radiation dose escalation improves prostate cancer outcomes and brachytherapy provides direct radiation dose escalation into the gland whilst minimizing dose to adjacent rectum and bladder. Two types of brachytherapy are commonly used: low dose rate (LDR), involving permanent implantation of radioactive seeds; and high dose rate (HDR), where the dose is delivered from a single radioactive source that moves through temporary implanted catheters. Current studies suggest that brachytherapy, either alone for low risk disease, or combined with external beam radiotherapy, for higher risk disease, results in improved prostate cancer control rates when compared to external beam radiotherapy alone. Improvements in brachytherapy technology have refined dose delivery with the more widespread introduction of HDR after loading devices, more sophisticated computerized treatment planning systems and the incorporation of 3D imaging into the planning process. This chapter provides an overview of the techniques, indications and clinical outcomes for both LDR and HDR prostate brachytherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hoskin PJ, Rojas AM, Bownes PJ, et al. Randomised trial of external beam radiotherapy alone or combined with high-dose rate brachytherapy boost for localised prostate cancer. Radiother Oncol. 2012;103(2):217–22.

    Article  PubMed  Google Scholar 

  2. Morris W, et al. LDR brachytherapy is superior to 78 Gy of EBRT for unfavourable risk prostate cancer: the results of a randomized trial. Radiother Oncol. 2015;115:S239.

    Article  Google Scholar 

  3. Holm HH, Juul N, Pedersen JF, et al. Transperineal125 iodine seed implantation in prostatic cancer guided by transrectal ultrasonography. J Urol. 1983;130:283–6.

    CAS  PubMed  Google Scholar 

  4. Blasko JC, Radge H, Schumacher D. Transperineal percutaneous iodine-125 implantation for prostatic carcinoma using transrectal ultrasound and template guidance. Endocurie/Hypertherm Oncol. 1987;3:131–9.

    Google Scholar 

  5. Nag S, et al. Intraoperative planning and evaluation of permanent prostate brachytherapy: report of the American Brachytherapy Society. IJROBP. 2001;51(5):1422–30.

    CAS  Google Scholar 

  6. Ash D, Flynn A, Batterman J, et al. ESTRA/EAU Urological Brachytherapy Group; EORTC Radiotherapy Group. ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother Oncol. 2000;57(3):315–21.

    Google Scholar 

  7. Salembier C, Lavagnini P, Nickers P, et al. GEC ESTRO PROBATE Group. Tumour and target volumes in permanent prostate brachytherapy: a supplement to the ESTRO/EAU/EORTC recommendations on prostate brachytherapy. Radiother Oncol. 2007;83(1):3–10.

    Google Scholar 

  8. Department of veterans affairs office of inspector general health inspection: review of brachytherapy treatment of prostate cancer, Philadelphia, Pennsylvania and Other VA Medical Centers Report No. 09-02815-143. Washington, DC: VA Office of Inspector General. 2010.

    Google Scholar 

  9. Davis BJ, Horwitz EM, Lee W, et al. American Brachytherapy Society consensus guidelines for transrectal ultra-sound guided permanent prostate brachytherapy. Brachytherapy. 2012;11(1):6–19.

    Article  PubMed  Google Scholar 

  10. The Royal College of Radiologists. Quality assurance practice guidelines for transperineal LDR permanent seed brachytherapy of prostate cancer. London: The Royal College of Radiologists; 2012.

    Google Scholar 

  11. Gelblum DY, Potters L, Ashley R, et al. Urinary morbidity following ultra-sound guided transperineal prostate seed implantation. IJROBP. 1999;45:59–67.

    CAS  Google Scholar 

  12. Martens C, et al. Relationship of the international prostate symptom score with urinary flow studies and catheterization rates following I-125 prostate brachytherapy. Brachytherapy. 2006;5:9–13.

    Article  PubMed  Google Scholar 

  13. Lee WR. The role of androgen deprivation therapy combined with prostate brachytherapy. Urology. 2002;37:565–9.

    Google Scholar 

  14. Sylvester JE, Grimm PD, Wong J, Galbreath RW, Merrick G, Blasko JC. Fifteen-year biochemical relapse-free survival, cause-specific survival, and overall survival following I(125) prostate brachytherapy in clinically localized prostate cancer: Seattle experience. Int J Radiat Oncol Biol Phys. 2011;81(2):376–81.

    Article  PubMed  Google Scholar 

  15. Potters L, Morgenstern C, Calugaru E, et al. 12-year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urol. 2005;173(5):1562–6.

    Article  PubMed  Google Scholar 

  16. Stone NN, Stone MM, Rosenstein BS, et al. Influence of pretreatment and treatment factors on intermediate to long-term outcome after prostate brachytherapy. J Urol. 2011;185:494–500.

    Article  Google Scholar 

  17. Zelefsky MJ, Chou JF, Pei X, et al. Predicting biocehmical control after brachytherapy for clinically localized prostate cancer: the Memorial Sloan-Kettering Cancer Centre experience. Brachytherapy. 2012;11:245–9.

    Article  PubMed  Google Scholar 

  18. Lawton CA, DeSilvio M, Lee WR, et al. Results of a phase II trial of transrectal ultrasound-guided permanent radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (RTOG 98–05). Int J Radiat Oncol Biol Phys. 2007;67(1):39–47.

    Article  PubMed  Google Scholar 

  19. Henry AM, Al-Qaisieh B, Gould K, et al. Outcomes following iodine-125 monotherapy for localized prostate cancer: the results of Leeds 10-year single-center brachytherapy experience. Int J Radiat Oncol Biol Phys. 2010;76:50–6.

    Article  PubMed  Google Scholar 

  20. Hinnen KA, Battermann JJ, van Roermond JGH, et al. Long term biochemical and survival outcome of 921 patients treated with I-125 permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2010;76:1433–8.

    Article  PubMed  Google Scholar 

  21. Grimm PD, Billiet I, Bostwick D, et al. Comparative analysis of prostate specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group. BJU Int. 2012;109(Suppl1):22–9.

    Article  PubMed  Google Scholar 

  22. Morris WJ, Keyes M, Spadinger I, et al. Population-based 10-year oncologic outcomes after low-dose-rate brachytherapy for low-risk and intermediate-risk prostate cancer. Cancer. 2013;119(8):1537–46.

    Article  PubMed  Google Scholar 

  23. Stock RG, Stone NN. Importance of post-implant dosimetry in permanent brachytherapy. Eur Urol. 2002;41(4):434–9.

    Article  PubMed  Google Scholar 

  24. Rodda SL, Tyldesley S, Morris WJ. Toxicity outcomes in ASCENDE-RT: a multicenter randomized trial of dose-escalation trial for prostate cancer. IJROBP. 2015;93(3):S121.

    Google Scholar 

  25. Rodda SL, Duncan G, Hamm J, Morris WJ. Quality of life outcomes: ASCENDE-RT a multicentre randomized trial of radiation therapy for prostate cancer. IJROBP. 2015;93(3):S2.

    Google Scholar 

  26. Zelefsky MJ, Shasha D, Branco RD, et al. Prophylactic sildenafil citrate for improvement of erectile function in men treated by radiotherapy for prostate cancer. J Urol. 2014;192(3):868–74.

    Article  CAS  PubMed  Google Scholar 

  27. Crook JM, Gomez-Iturriaga A, Wallace K, et al. Comparison of health-related quality of life 5 years after SPIRIT: surgical prostatectomy versus interstitial radiation intervention trial. JCO. 2011;29:362–8.

    Article  Google Scholar 

  28. Pardo Y, Guedea F, Aguilo F, et al. Quality of life impacts of primary treatments for localized prostate cancer in patients without hormonal treatment. JCO. 2010;28:4687–96.

    Article  Google Scholar 

  29. Chen RC, Clark JA, Talcott JA. Individualizing quality-of-life outcomes reporting: how localized prostate cancer treatments affect patients with different levels of baseline urinary, bowel and sexual function. JCO. 2009;27:3916–22.

    Article  Google Scholar 

  30. Ferrer M, et al. Quality of life impact of treatments for localized prostate cancer: cohort study with a 5-year follow-up. Radiother Oncol. 2013;108(2):306–13.

    Article  PubMed  Google Scholar 

  31. Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcomes among prostate-cancer survivors. New Engl J Med. 2008;358:1250–61.

    Article  CAS  PubMed  Google Scholar 

  32. Hoskin PJ, Colombo A, Henry A, et al. GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: an update. Radiother Oncol. 2013;107(3):325–32.

    Article  PubMed  Google Scholar 

  33. Martinez AA, Gonzalez J, Ye H, et al. Dose escalation improves cancer related events at 10 years for intermediate and high risk prostate cancer patients treated with hypofractionated high-dose-rate boost and external beam radiotherapy. IJROBP. 2011;79(2):363–70.

    Google Scholar 

  34. Hoskin P, Rojas A, Ostler P, et al. Dosimetric predictors of biochemical control of prostate cancer in patients randomised to EBRT with a boost of HDR. RO. 2014;110:110–3.

    Google Scholar 

  35. Morton G, Loblaw DA, Sankreacha A, et al. Single-fraction high dose rate brachytherapy and hypofractionated external beam radiotherapy for men with intermediate risk prostate cancer: an analysis of short and medium term toxicity and quality of life. Int J Radiat Oncol Biol Phys. 2010;77:811–7.

    Article  PubMed  Google Scholar 

  36. Morton G, Loblaw A, Cheung P, Szumacher E, Chahal M, Danjoux C, Chung HT, Deabreu Mamedov A, Zhang L, Sankreacha R, Vigneault E, Springer C. Is single fraction 15 Gy the preferred high dose-rate brachytherapy boost dose for prostate cancer? Radiother Oncol. 2011;100:463–7.

    Article  PubMed  Google Scholar 

  37. Ghilezan M, Martinez A, Gustason G, Krauss D, Antonucci JV, Chen P, et al. High-dose-rate brachytherapy as monotherapy delivered in two fractions within one day for favorable/intermediate-risk prostate cancer: preliminary toxicity data. Int J Radiat Oncol Biol Phys. 2012;83(3):927–32.

    Article  PubMed  Google Scholar 

  38. Yoshioka Y, Konishi K, Sumida I, Takahashi Y, Isohashi F, Ogata T, et al. Monotherapeutic high-dose-rate brachytherapy for prostate cancer: five-year results of an extreme hypofractionation regimen with 54 Gy in nine fractions. Int J Radiat Oncol Biol Phys. 2011;80(2):469–75.

    Article  PubMed  Google Scholar 

  39. Barkati M, Williams SG, Foroudi F, Tai KH, Chander S, van Dyk S, et al. High-dose-rate brachytherapy as a monotherapy for favorable-risk prostate cancer: a Phase II trial. Int J Radiat Oncol Biol Phys. 2012;82(5):1889–96.

    Article  PubMed  Google Scholar 

  40. Hauswald H, Kamrava MR, Fallon JM, et al. High-dose-rate monotherapy for localized prostate cancer: 10 -year results. Int J Radiat Oncol Biol Phys. 2016;94(4):667–74.

    Article  PubMed  Google Scholar 

  41. Prada PJ, Jimenez I, Gonzalez-Suarez H, Fernandez J, Cuervo-Arango C, Mendez L. High-dose-rate interstitial brachytherapy as monotherapy in one fraction and transperineal hyaluronic acid injection into the perirectal fat for the treatment of favorable stage prostate cancer: treatment description and preliminary results. Brachytherapy. 2012;11(2):105–10.

    Article  PubMed  Google Scholar 

  42. Roger CL, Alders AS, Rogers RL, et al. High dose rate brachytherapy as monotherapy for intermediate risk prostate cancer. J Urol 2012;187:109–16.

    Google Scholar 

  43. Hoskin P, Rojas A, Ostler P, et al. HDR brachytherapy alone given as two or one fraction to patients for locally advanced prostate cancer: acute toxicity. RO. 2014;110:268–71.

    Google Scholar 

  44. Zamboglou N, Tselis N, Baltas D, Buhleier T, Martin T, Milickovic N, et al. High-dose-rate interstitial brachytherapy as monotherapy for clinically localized prostate cancer: treatment evolution and mature results. Int J Radiat Oncol Biol Phys. 2013;85:672–8.

    Article  PubMed  Google Scholar 

  45. Chen CP, Weinberg V, Shinohara K, et al. Salvage HDR brachytherapy for recurrent prostate cancer after previous definitive radiation therapy: 5-year outcomes. IJROBP. 2013;86:324–9.

    Google Scholar 

  46. Tharp M, Hardacre M, Bennett R, et al. Prostate high-dose-rate brachytherapy as salvage treatment of local failure after previous external or permanent seed irradiation for prostate cancer. Brachytherapy. 2008;7:231–6.

    Article  PubMed  Google Scholar 

  47. Morton GC. High-dose-rate brachytherapy boost for prostate cancer: rationale and technique. J Contemp Brachytherapy. 2014;6(3):323–30.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Spratt DE, Zumsteg ZS, Ghadjar P, et al. Comparison of high-dose (86.4Gy) IMRT vs. combined brachytherapy plus IMRT for intermediate-risk prostate cancer. BJU Int. 2014;114:360–7.

    PubMed  Google Scholar 

  49. Pieters BR, de Back DZ, Koning CCE, Zwinderman AH. Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: a systematic review. Radiother Oncol. 2009;93(2):168–73.

    Article  PubMed  Google Scholar 

  50. Martinez AA, Demanes J, Vargas C, et al. High-dose-rate prostate brachytherapy: an excellent accelerated-hypofractionated treatment for favorable prostate cancer. Am J Clin Oncol. 2010;33:481–8.

    Article  PubMed  Google Scholar 

  51. Morton GC, Loblaw DA, Chung H, et al. Health-related quality of life after single-fraction high-dose-rate brachytherapy and hypofractionated external beam radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2011;80:1299–305.

    Article  PubMed  Google Scholar 

  52. Challapalli A, Jones E, Harvey C, Hellawell GO, Mangar SA. High dose rate prostate brachytherapy: an overview of the rationale, experience and emerging applications in the treatment of prostate cancer. Br J Radiol. 2012;85:S18–27.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ann Henry .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Henry, A. (2017). Permanent and High Dose Rate Brachytherapy (Technique, Indications, Results, Morbidity). In: Bolla, M., van Poppel, H. (eds) Management of Prostate Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-42769-0_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42769-0_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42768-3

  • Online ISBN: 978-3-319-42769-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics