The effectiveness of high-dose-rate brachytherapy with external beam radiotherapy for clinically locally advanced and node-positive prostate cancer: long-term results of a retrospective study.

Abstract

BACKGROUND:

No standard treatment exists for locally advanced prostate cancer (PC). This study evaluated the long-term treatment outcomes and toxicity in patients with clinically locally advanced and/or lymph node (LN)-positive PC who underwent high-dose-rate brachytherapy (HDR-BT) with external beam radiotherapy (EBRT).

METHODS:

The treatment outcomes and toxicities of 152 patients with PC who underwent HDR-BT with EBRT and had at least 2 years of observation were examined. The treatment dose was 19- and 13-Gy HDR-BT in two and single fractions, respectively, both combined with external irradiation of 46 Gy in 23 fractions. Long-term androgen deprivation therapy (ADT) for patients harboring very high-risk tumors was used in combination.

RESULTS:

The median observation period was 59.7 (24.4-182.1) months. The 5-year prostate cancer-specific and recurrence-free (RFS) survival rates were 99.0% and 91.8%, respectively, with only two PC mortalities. When 5-year RFS was examined for each parameter, RFS was significantly lower in pre-radiotherapy (pre-RT) prostate-specific antigen (PSA) > 0.5 ng/mL (77.1%; p = 0.008), and presence of LN metastasis (68.1%; p = 0.017). Multivariable analysis demonstrated that pre-RT PSA (HR, 4.68; 95% CI, 1.39-15.67; p = 0.012) and presence of LN metastasis (HR, 4.70; 95% CI, 1.24-17.74; p = 0.022) were independent recurrence predictors. The 5-year cumulative incidence rate of grade ≥ 2 toxicities in genitourinary and gastrointestinal tracts were 15.4% and 1.3%, respectively.

CONCLUSIONS:

HDR-BT combined with EBRT and long-term ADT shows promising disease control and tolerant toxicities for clinically locally advanced and LN-positive PC.

• Authors: Tomoyuki Makino, Takayuki Sakurai, Shigeyuki Takamatsu, Hiroaki Iwamoto, Hiroshi Yaegashi, Masashi Iijima, Shohei Kawaguchi, Takahiro Nohara, Kazuyoshi Shigehara, Kouji Izumi, Yoshifumi Kadono, Atsushi Mizokami
• Journal: International journal of clinical oncology (Int J Clin Oncol) Vol. 26 Issue 12 Pg. 2310-2317 (Dec 2021) ISSN: 1437-7772 [Electronic] Japan
• PMID: 34494172 (Publication Type: Journal Article)
• Copyright: © 2021. Japan Society of Clinical Oncology.

Chemical References

• Androgen Antagonists
• KLK3 protein, human
• Kallikreins
• Prostate-Specific Antigen

Topics

• Androgen Antagonists
• Brachytherapy
• Humans
• Kallikreins
• Male
• Neoplasm Recurrence, Local
• Prostate-Specific Antigen
• Prostatic Neoplasms (radiotherapy)
• Radiotherapy Dosage
• Retrospective Studies