Brachytherapy pp 199-206 | Cite as

Single-Fraction HDR Boost

  • Cristina GutiérrezEmail author
  • Andrea Slocker
  • Dina Najjari
  • Ignasi Modolell
  • Ferran Ferrer
  • Anna Boladeras
  • Jose Francisco Suárez
  • Ferran Guedea


In this chapter, the authors are going to describe the reason why we propose to administer the boost with a single dose of HDR brachytherapy: first, it is an excellent way to escalate the dose, and second it is a very accurate and sure method.

We are going to comment about different authors that are using single-dose boost or several fraction boost and the advantages and withdrawals of both. The main advantage is that we only need one surgical procedure for needle insertion, and thus movement between fractions can be avoided. And it can be done in real-time administering the brachytherapy in the operating theatre.

We are going to discuss about dose equivalence to normofractionation using alpha-beta model. And last, we are going to describe our technique in detail and our institution’s result.


Prostate neoplasm High-risk prostate cancer HDR boost Single-fraction boost Combined treatment Prostate brachytherapy 


  1. 1.
    Martinez AA, Gustafson G, Gonzalez J, et al. Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer. Int J Radiat Oncol Biol Phys. 2002;53(2):316–27.CrossRefPubMedGoogle Scholar
  2. 2.
    Vargas CE, Martinez AA, al BTP e. High-dose irradiation for prostate cancer via a high-dose-rate brachytherapy boost: results of a phase I to II study. Int J Radiat Oncol Biol Phys. 2006;66(2):416–23.CrossRefPubMedGoogle Scholar
  3. 3.
    Al-Mamgani A, van Putten WLJ, Heemsbergen WD, et al. Update of Dutch multicenter dose-escalation trial of radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;72:980–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Dearnaley DP, Sydes MR, Graham JD, et al. Escalated-dose versus standard dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2007;8:475–87.CrossRefPubMedGoogle Scholar
  5. 5.
    Kuban DA, Tucker SL, Dong L, et al. Long-term results of the M.D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70:67–74.CrossRefPubMedGoogle Scholar
  6. 6.
    Peeters STH, Heemsbergen WD, van Putten WLJ, et al. Acute and late complications after radiotherapy for prostate cancer: results of a multicenter randomized trial comparing 68Gy to 78 Gy. Int J Radiat Oncol Biol Phys. 2005;61:1019–34.CrossRefPubMedGoogle Scholar
  7. 7.
    Pistis F, Guedea F, Pera J, et al. External beam radiotherapy plus high-dose-rate brachytherapy for treatment of locally advanced prostate cancer: the initial experience of the Catalan Institute of Oncology. Brachytherapy. 2010;9(1):15–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Boladeras A, Santorsa L, Gutierrez C, et al. External beam radiotherapy plus single-fraction high dose rate brachytherapy in the treatment of locally advanced prostate cancer. Radiother Oncol. 2014;112(2):227–32.CrossRefPubMedGoogle Scholar
  9. 9.
    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;103:217–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Agoston P, Major T, Fröhlich G, et al. Moderate dose escalation with single-fraction high-dose-rate brachytherapy boost for clinically localized intermediate- and high-risk prostate cancer: 5-year outcome of the first 100 consecutively treated patients. Brachytherapy. 2011;10:376–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Galalae RM, Martinez A, Nuernberg N, et al. Hypofractionated conformal HDR brachytherapy in hormone naïve men with localized prostate cancer. Is escalation to very high biologically equivalent dose beneficial in all prognostic risk groups? Strahlenther Onkol. 2006;182:135–41.CrossRefPubMedGoogle Scholar
  12. 12.
    Galalae RM, Zakikhany NH, Geiger F, et al. The 15-year outcomes of high-dose-rate brachytherapy for radical dose escalation in patients with prostate cancer-a benchmark for high-tech external beam radiotherapy alone? Brachytherapy. 2014;13:117–22.CrossRefPubMedGoogle Scholar
  13. 13.
    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. Scholar
  14. 14.
    Vigneault E, Mbodji K, Magnan S, et al. High-dose-rate brachytherapy boost for prostate cancer treatment: different combinations of hypofractionated regimens and clinical outcomes. Radiother Oncol. 2017;124(1):49–55. Scholar
  15. 15.
    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. Int J Radiat Oncol Biol Phys. 2011;79:363–70.CrossRefPubMedGoogle Scholar
  16. 16.
    Yamada Y, Bhatia S, Zaider M, et al. Favorable clinical outcomes of three dimensional computer-optimized high-dose-rate prostate brachytherapy in the management of localized prostate cancer. Brachytherapy. 2006;5:157–64.CrossRefPubMedGoogle Scholar
  17. 17.
    Morton G, Loblaw A, Cheung P, et al. Is single fraction 15 Gy the preferred high dose-rate brachytherapy boost dose for prostate cancer? Radiother Oncol. 2011;100:463–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Hoskin PJ, Bownes PJ, Ostler P, et al. High dose rate afterloading brachytherapy for prostate cancer: catheter and gland movement between fractions. Radiother Oncol. 2003;68:285–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Reynés-Llompart G, Pino F, Modolell I, Gullón C, et al. Impact of prostate catheter displacement in inverse planning--simulated annealing and geometric optimization. Brachytherapy. 2016;15(1):112–7. Scholar
  20. 20.
    Aitkenhead AR. Injuries associated with anaesthesia. A global perspective. Br J Anaesth. 2005;95:95–109.CrossRefPubMedGoogle Scholar
  21. 21.
    Fatyga M, Williamson JF, Dogan N, et al. A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: a radiobiological modeling study. Med Phys. 2009;36:3995–4006.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Proust-Lima C, Taylor JMG, Sécher S, et al. Confirmation of a low a/b ratio for prostate cancer treated by external beam radiation therapy alone using a posttreatment repeated-measures model for PSA dynamics. Int J Radiat Oncol Biol Phys. 2011;79:195–201.CrossRefPubMedGoogle Scholar
  23. 23.
    Nag S, Gupta N. A simple method of obtaining equivalent doses for use in HDR brachytherapy. Int J Radiat Oncol Biol Phys. 2000;46:507–13.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Cristina Gutiérrez
    • 1
    Email author
  • Andrea Slocker
    • 1
  • Dina Najjari
    • 1
  • Ignasi Modolell
    • 2
  • Ferran Ferrer
    • 1
  • Anna Boladeras
    • 1
  • Jose Francisco Suárez
    • 3
  • Ferran Guedea
    • 1
  1. 1.Department of Radiation OncologyInstitut Català d’Oncologia, L’HospitaletBarcelonaSpain
  2. 2.Department of Medical Physics and Radiation ProtectionInstitut Català d’Oncologia, L’HospitaletBarcelonaSpain
  3. 3.Department of UrologyHospital Universitari de Bellvitge, L’HospitaletBarcelonaSpain

Personalised recommendations