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Long-term clinical outcomes of 538 prostate carcinoma patients treated with combination high-dose-rate brachytherapy and external beam radiotherapy

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Purpose

We report on the long-term clinical outcomes of clinically localized prostate carcinoma (PCa) patients treated with external beam radiotherapy (EBRT) in combination with high-dose-rate brachytherapy boost (HDR-B).

Material and methods

Between 2002 and 2015, 538 prostate carcinoma patients underwent combined HDR-B (Ir-192) of 16 Gy over 4 fractions and EBRT of 59.4 Gy over 33 fractions. Patients were segregated into risk groups according to the NCCN guidelines. The Cox proportional hazards model was used to elicit risk factors for decreased biochemical relapse-free survival (bRFS), distant metastasis-free survival (dMFS), and overall survival (OS). Patients were graded by a board of radiation oncologists for gastrointestinal (GI) and genitourinary (GU) adverse events due to radiation using CTCAE v4.03 guidelines at follow-up.

Results

The mean follow-up was 49 months (range 6–145 months). Five-year bRFS for low-, intermediate-, and high-risk patients were 96.7%, 93.0%, and 78.5%, respectively. Five-year dMFS for low-, intermediate-, and high-risk patients were 100%, 96.4%, and 80.7%, respectively. Five-year OS rates for low-, intermediate-, and high-risk patients were 98.6%, 97.5%, and 94.7%, respectively. Five-year incidence of late grade 2 and 3 GI toxicities were 6.3% and 0.7%, respectively, and the five-year incidence of late grade 2 and 3 GU toxicities were 11.7% and 1.3%, respectively. Multivariate analysis revealed a higher Gleason score, initial pre-treatment PSA, and no hormonal therapy use as predictive for decreased biochemical control.

Conclusion

Combined HDR-B/EBRT for the treatment of clinically localized prostate cancer provides superb clinical outcomes with excellent 5-year bRFS, dMFS, OS, and late GI/GU toxicity rates.

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Contributions

(i) Conception and design: BML, KT; (ii) administrative support: KT; (iii) provision of study materials or patients: JY, RT, RB, MG, AW, CP, SC, KT; (iv) collection and assembly of data: BML, NM; (v) statistical analysis and interpretation: BML; (vi) manuscript writing—original draft: BML; (vii) final approval of manuscript: all authors.

Funding

A portion of the study was funded by the Medici Foundation (non-profit organization).

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Authors and Affiliations

  1. Department of Radiation Oncology, Cancer Center of Irvine, 16100 Sand Canyon Ste #130, Irvine, CA, 92618, USA

    Brandon M. Lehrich, John Ravera, Navid Mostaghni, Jeffrey Yoshida, Robert Torrey, Ruben Baghdassarian, Michael Gazzaniga, Alan Weinberg, Cu Phan, Stuart Chalfin, Lucy Barnes, Albert Mesa & Kenneth Tokita

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  1. Brandon M. Lehrich
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Lehrich, B.M., Ravera, J., Mostaghni, N. et al. Long-term clinical outcomes of 538 prostate carcinoma patients treated with combination high-dose-rate brachytherapy and external beam radiotherapy. J Radiat Oncol 8, 311–321 (2019). https://doi.org/10.1007/s13566-019-00401-2

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