Dose escalation with external beam radiation therapy and high-dose-rate brachytherapy combined with long-term androgen deprivation therapy in high and very high risk prostate cancer: Comparison of two consecutive high-dose-rate schemes

Abstract Purpose To compare rectal toxicity, urinary toxicity, and nadir+2 PSA relapse-free survival (bRFS) in two consecutive Phase II protocols of high-dose-rate (HDR) brachytherapy used at the authors institution from 2001 to 2012. Methods and Materials Patients with National Comprehensive Cancer...

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Veröffentlicht in:Brachytherapy 2016-03, Vol.15 (2), p.127-135
Hauptverfasser: Olarte, Alicia, Cambeiro, Mauricio, Moreno-Jiménez, Marta, Arbea, Leire, Pérez-Gracia, José Luis, Gil-Bazo, Ignacio, Pascual, Ignacio, Aristu, Javier, Martínez-Monge, Rafael
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container_end_page 135
container_issue 2
container_start_page 127
container_title Brachytherapy
container_volume 15
creator Olarte, Alicia
Cambeiro, Mauricio
Moreno-Jiménez, Marta
Arbea, Leire
Pérez-Gracia, José Luis
Gil-Bazo, Ignacio
Pascual, Ignacio
Aristu, Javier
Martínez-Monge, Rafael
description Abstract Purpose To compare rectal toxicity, urinary toxicity, and nadir+2 PSA relapse-free survival (bRFS) in two consecutive Phase II protocols of high-dose-rate (HDR) brachytherapy used at the authors institution from 2001 to 2012. Methods and Materials Patients with National Comprehensive Cancer Network high risk and very high risk prostate cancer enrolled in studies HDR4 (2001–2007, n  = 183) and HDR2 (2007–2012, n  = 56) were analyzed. Patients received minipelvis external beam radiation therapy/intensity-modulated external radiotherapy to 54 Gy and 2 years of androgen blockade along with HDR brachytherapy. HDR4 protocol consisted of four 4.75 Gy fractions delivered in 48 hours; the HDR2 protocol delivered two 9.5 Gy fractions in 24 hours. Average 2-Gy equivalent dose (α/β = 1.2) prostate D90 doses for the HDR4 and HDR2 groups were 89.8 Gy and 110.5 Gy, respectively ( p  = 0.0001). Both groups were well balanced regarding risk factors. Prior transurethral resection of the prostate was more frequent in the HDR2 group ( p  = 0.001). Results After a median followup of 7.4 years (range, 2–11.2), there was no difference in adverse grade ≥ 2 rectal events (HDR4 = 10.4% vs. HDR2 = 12.5%; p  = ns) or grade ≥3 (HDR4 = 2.2% vs. HDR2 = 3.6%; p  = ns). No differences in urinary grade ≥2 adverse events (HDR4 = 23% vs. HDR2 = 26.8%; p  = ns) or grade ≥3 (HDR4 = 7.7% vs. HDR2 = 8.9%; p  = ns) were detected. The 7-year bRFS for HDR4 and HDR2 protocols was 88.7% and 87.8%, respectively ( p  = ns). Conclusions HDR4 and HDR2 protocols produce similar results in terms of toxicity and bRFS at the intermediate time point of 7 years.
doi_str_mv 10.1016/j.brachy.2015.12.008
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Methods and Materials Patients with National Comprehensive Cancer Network high risk and very high risk prostate cancer enrolled in studies HDR4 (2001–2007, n  = 183) and HDR2 (2007–2012, n  = 56) were analyzed. Patients received minipelvis external beam radiation therapy/intensity-modulated external radiotherapy to 54 Gy and 2 years of androgen blockade along with HDR brachytherapy. HDR4 protocol consisted of four 4.75 Gy fractions delivered in 48 hours; the HDR2 protocol delivered two 9.5 Gy fractions in 24 hours. Average 2-Gy equivalent dose (α/β = 1.2) prostate D90 doses for the HDR4 and HDR2 groups were 89.8 Gy and 110.5 Gy, respectively ( p  = 0.0001). Both groups were well balanced regarding risk factors. Prior transurethral resection of the prostate was more frequent in the HDR2 group ( p  = 0.001). Results After a median followup of 7.4 years (range, 2–11.2), there was no difference in adverse grade ≥ 2 rectal events (HDR4 = 10.4% vs. HDR2 = 12.5%; p  = ns) or grade ≥3 (HDR4 = 2.2% vs. HDR2 = 3.6%; p  = ns). No differences in urinary grade ≥2 adverse events (HDR4 = 23% vs. HDR2 = 26.8%; p  = ns) or grade ≥3 (HDR4 = 7.7% vs. HDR2 = 8.9%; p  = ns) were detected. The 7-year bRFS for HDR4 and HDR2 protocols was 88.7% and 87.8%, respectively ( p  = ns). Conclusions HDR4 and HDR2 protocols produce similar results in terms of toxicity and bRFS at the intermediate time point of 7 years.</description><identifier>ISSN: 1538-4721</identifier><identifier>EISSN: 1873-1449</identifier><identifier>DOI: 10.1016/j.brachy.2015.12.008</identifier><identifier>PMID: 26832677</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>3DCRT ; Aged ; Aged, 80 and over ; Androgen Antagonists - therapeutic use ; Androgen deprivation therapy ; Brachytherapy - adverse effects ; Brachytherapy - methods ; Chemoradiotherapy ; Disease-Free Survival ; Follow-Up Studies ; HDR brachytherapy ; Hematology, Oncology and Palliative Medicine ; High risk ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local - etiology ; Prostate cancer ; Prostate-Specific Antigen - blood ; Prostatectomy ; Prostatic Neoplasms - blood ; Prostatic Neoplasms - radiotherapy ; Radiation Injuries - etiology ; Radiology ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated - adverse effects ; Radiotherapy, Intensity-Modulated - methods ; Rectum - radiation effects ; Risk Factors ; Treatment Outcome ; Urinary Bladder - radiation effects</subject><ispartof>Brachytherapy, 2016-03, Vol.15 (2), p.127-135</ispartof><rights>American Brachytherapy Society</rights><rights>2016 American Brachytherapy Society</rights><rights>Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c487t-9ed0f853ce8137f1e35503b8f27ae06b16904ab15d705c40228291c0cc361f6c3</citedby><cites>FETCH-LOGICAL-c487t-9ed0f853ce8137f1e35503b8f27ae06b16904ab15d705c40228291c0cc361f6c3</cites><orcidid>0000-0002-6285-4816</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.brachy.2015.12.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26832677$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Olarte, Alicia</creatorcontrib><creatorcontrib>Cambeiro, Mauricio</creatorcontrib><creatorcontrib>Moreno-Jiménez, Marta</creatorcontrib><creatorcontrib>Arbea, Leire</creatorcontrib><creatorcontrib>Pérez-Gracia, José Luis</creatorcontrib><creatorcontrib>Gil-Bazo, Ignacio</creatorcontrib><creatorcontrib>Pascual, Ignacio</creatorcontrib><creatorcontrib>Aristu, Javier</creatorcontrib><creatorcontrib>Martínez-Monge, Rafael</creatorcontrib><title>Dose escalation with external beam radiation therapy and high-dose-rate brachytherapy combined with long-term androgen deprivation therapy in high and very high risk prostate cancer: Comparison of two consecutive high-dose-rate schemes</title><title>Brachytherapy</title><addtitle>Brachytherapy</addtitle><description>Abstract Purpose To compare rectal toxicity, urinary toxicity, and nadir+2 PSA relapse-free survival (bRFS) in two consecutive Phase II protocols of high-dose-rate (HDR) brachytherapy used at the authors institution from 2001 to 2012. Methods and Materials Patients with National Comprehensive Cancer Network high risk and very high risk prostate cancer enrolled in studies HDR4 (2001–2007, n  = 183) and HDR2 (2007–2012, n  = 56) were analyzed. Patients received minipelvis external beam radiation therapy/intensity-modulated external radiotherapy to 54 Gy and 2 years of androgen blockade along with HDR brachytherapy. HDR4 protocol consisted of four 4.75 Gy fractions delivered in 48 hours; the HDR2 protocol delivered two 9.5 Gy fractions in 24 hours. Average 2-Gy equivalent dose (α/β = 1.2) prostate D90 doses for the HDR4 and HDR2 groups were 89.8 Gy and 110.5 Gy, respectively ( p  = 0.0001). Both groups were well balanced regarding risk factors. Prior transurethral resection of the prostate was more frequent in the HDR2 group ( p  = 0.001). Results After a median followup of 7.4 years (range, 2–11.2), there was no difference in adverse grade ≥ 2 rectal events (HDR4 = 10.4% vs. HDR2 = 12.5%; p  = ns) or grade ≥3 (HDR4 = 2.2% vs. HDR2 = 3.6%; p  = ns). No differences in urinary grade ≥2 adverse events (HDR4 = 23% vs. HDR2 = 26.8%; p  = ns) or grade ≥3 (HDR4 = 7.7% vs. HDR2 = 8.9%; p  = ns) were detected. The 7-year bRFS for HDR4 and HDR2 protocols was 88.7% and 87.8%, respectively ( p  = ns). Conclusions HDR4 and HDR2 protocols produce similar results in terms of toxicity and bRFS at the intermediate time point of 7 years.</description><subject>3DCRT</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Androgen Antagonists - therapeutic use</subject><subject>Androgen deprivation therapy</subject><subject>Brachytherapy - adverse effects</subject><subject>Brachytherapy - methods</subject><subject>Chemoradiotherapy</subject><subject>Disease-Free Survival</subject><subject>Follow-Up Studies</subject><subject>HDR brachytherapy</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>High risk</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - etiology</subject><subject>Prostate cancer</subject><subject>Prostate-Specific Antigen - blood</subject><subject>Prostatectomy</subject><subject>Prostatic Neoplasms - blood</subject><subject>Prostatic Neoplasms - radiotherapy</subject><subject>Radiation Injuries - etiology</subject><subject>Radiology</subject><subject>Radiotherapy Dosage</subject><subject>Radiotherapy, Intensity-Modulated - adverse effects</subject><subject>Radiotherapy, Intensity-Modulated - methods</subject><subject>Rectum - radiation effects</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><subject>Urinary Bladder - radiation effects</subject><issn>1538-4721</issn><issn>1873-1449</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUstu1DAUjRCIloE_QMhLNgl-JLGHBRKa8pIqsQDWluPcTDxN7MF2puSb-xN1mhaJbljZlu855957Tpa9JrggmNTvDkXjle7ngmJSFYQWGIsn2TkRnOWkLLdP071iIi85JWfZixAOOMG2jD3PzmgtGK05P89uLlwABEGrQUXjLLo2sUfwJ4K3akANqBF51Zr1M_bg1XFGyraoN_s-bxM69yoCWpt5KNBubIyFdqUbnN3niXFcgN7twaIWjt6c_mU19o70jv0Efl5f3oQrdPQuxEVGK6vBv0c7Nx5V-kpw16F47ZKkDaCnaE7wuLegexghvMyedWoI8Or-3GS_Pn_6ufuaX37_8m338TLXpeAx30KLO1ExDYIw3hFgVYVZIzrKFeC6SUvEpWpI1XJc6RJTKuiWaKw1q0lXa7bJ3q68qevfE4QoRxM0DIOy4KYgCedUsJInjU1WrqU6DRg8dDKtZVR-lgTLxWZ5kOtm5WKzJFQmmxPszb3C1IzQ_gU9-JoKPqwFkOY8GfAyaANpda3xoKNsnfmfwmMCPRhrUkyuYIZwcNOSjzSLDAkgfyxRW5JGKoxrVmJ2C8Eg1i4</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Olarte, Alicia</creator><creator>Cambeiro, Mauricio</creator><creator>Moreno-Jiménez, Marta</creator><creator>Arbea, Leire</creator><creator>Pérez-Gracia, José Luis</creator><creator>Gil-Bazo, Ignacio</creator><creator>Pascual, Ignacio</creator><creator>Aristu, Javier</creator><creator>Martínez-Monge, Rafael</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6285-4816</orcidid></search><sort><creationdate>20160301</creationdate><title>Dose escalation with external beam radiation therapy and high-dose-rate brachytherapy combined with long-term androgen deprivation therapy in high and very high risk prostate cancer: Comparison of two consecutive high-dose-rate schemes</title><author>Olarte, Alicia ; Cambeiro, Mauricio ; Moreno-Jiménez, Marta ; Arbea, Leire ; Pérez-Gracia, José Luis ; Gil-Bazo, Ignacio ; Pascual, Ignacio ; Aristu, Javier ; Martínez-Monge, Rafael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c487t-9ed0f853ce8137f1e35503b8f27ae06b16904ab15d705c40228291c0cc361f6c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>3DCRT</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Androgen Antagonists - therapeutic use</topic><topic>Androgen deprivation therapy</topic><topic>Brachytherapy - adverse effects</topic><topic>Brachytherapy - methods</topic><topic>Chemoradiotherapy</topic><topic>Disease-Free Survival</topic><topic>Follow-Up Studies</topic><topic>HDR brachytherapy</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>High risk</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - etiology</topic><topic>Prostate cancer</topic><topic>Prostate-Specific Antigen - blood</topic><topic>Prostatectomy</topic><topic>Prostatic Neoplasms - blood</topic><topic>Prostatic Neoplasms - radiotherapy</topic><topic>Radiation Injuries - etiology</topic><topic>Radiology</topic><topic>Radiotherapy Dosage</topic><topic>Radiotherapy, Intensity-Modulated - adverse effects</topic><topic>Radiotherapy, Intensity-Modulated - methods</topic><topic>Rectum - radiation effects</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><topic>Urinary Bladder - radiation effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Olarte, Alicia</creatorcontrib><creatorcontrib>Cambeiro, Mauricio</creatorcontrib><creatorcontrib>Moreno-Jiménez, Marta</creatorcontrib><creatorcontrib>Arbea, Leire</creatorcontrib><creatorcontrib>Pérez-Gracia, José Luis</creatorcontrib><creatorcontrib>Gil-Bazo, Ignacio</creatorcontrib><creatorcontrib>Pascual, Ignacio</creatorcontrib><creatorcontrib>Aristu, Javier</creatorcontrib><creatorcontrib>Martínez-Monge, Rafael</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Brachytherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Olarte, Alicia</au><au>Cambeiro, Mauricio</au><au>Moreno-Jiménez, Marta</au><au>Arbea, Leire</au><au>Pérez-Gracia, José Luis</au><au>Gil-Bazo, Ignacio</au><au>Pascual, Ignacio</au><au>Aristu, Javier</au><au>Martínez-Monge, Rafael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dose escalation with external beam radiation therapy and high-dose-rate brachytherapy combined with long-term androgen deprivation therapy in high and very high risk prostate cancer: Comparison of two consecutive high-dose-rate schemes</atitle><jtitle>Brachytherapy</jtitle><addtitle>Brachytherapy</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>15</volume><issue>2</issue><spage>127</spage><epage>135</epage><pages>127-135</pages><issn>1538-4721</issn><eissn>1873-1449</eissn><abstract>Abstract Purpose To compare rectal toxicity, urinary toxicity, and nadir+2 PSA relapse-free survival (bRFS) in two consecutive Phase II protocols of high-dose-rate (HDR) brachytherapy used at the authors institution from 2001 to 2012. Methods and Materials Patients with National Comprehensive Cancer Network high risk and very high risk prostate cancer enrolled in studies HDR4 (2001–2007, n  = 183) and HDR2 (2007–2012, n  = 56) were analyzed. Patients received minipelvis external beam radiation therapy/intensity-modulated external radiotherapy to 54 Gy and 2 years of androgen blockade along with HDR brachytherapy. HDR4 protocol consisted of four 4.75 Gy fractions delivered in 48 hours; the HDR2 protocol delivered two 9.5 Gy fractions in 24 hours. Average 2-Gy equivalent dose (α/β = 1.2) prostate D90 doses for the HDR4 and HDR2 groups were 89.8 Gy and 110.5 Gy, respectively ( p  = 0.0001). Both groups were well balanced regarding risk factors. Prior transurethral resection of the prostate was more frequent in the HDR2 group ( p  = 0.001). Results After a median followup of 7.4 years (range, 2–11.2), there was no difference in adverse grade ≥ 2 rectal events (HDR4 = 10.4% vs. HDR2 = 12.5%; p  = ns) or grade ≥3 (HDR4 = 2.2% vs. HDR2 = 3.6%; p  = ns). No differences in urinary grade ≥2 adverse events (HDR4 = 23% vs. HDR2 = 26.8%; p  = ns) or grade ≥3 (HDR4 = 7.7% vs. HDR2 = 8.9%; p  = ns) were detected. The 7-year bRFS for HDR4 and HDR2 protocols was 88.7% and 87.8%, respectively ( p  = ns). Conclusions HDR4 and HDR2 protocols produce similar results in terms of toxicity and bRFS at the intermediate time point of 7 years.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26832677</pmid><doi>10.1016/j.brachy.2015.12.008</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6285-4816</orcidid></addata></record>
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subjects 3DCRT
Aged
Aged, 80 and over
Androgen Antagonists - therapeutic use
Androgen deprivation therapy
Brachytherapy - adverse effects
Brachytherapy - methods
Chemoradiotherapy
Disease-Free Survival
Follow-Up Studies
HDR brachytherapy
Hematology, Oncology and Palliative Medicine
High risk
Humans
Male
Middle Aged
Neoplasm Recurrence, Local - etiology
Prostate cancer
Prostate-Specific Antigen - blood
Prostatectomy
Prostatic Neoplasms - blood
Prostatic Neoplasms - radiotherapy
Radiation Injuries - etiology
Radiology
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated - adverse effects
Radiotherapy, Intensity-Modulated - methods
Rectum - radiation effects
Risk Factors
Treatment Outcome
Urinary Bladder - radiation effects
title Dose escalation with external beam radiation therapy and high-dose-rate brachytherapy combined with long-term androgen deprivation therapy in high and very high risk prostate cancer: Comparison of two consecutive high-dose-rate schemes
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