Individualized Dose-Escalation of HDR Prostate Brachytherapy Implant to Decrease Required External Beam Radiation Dose: A Retrospective Feasibility Study

Overview

Journal Adv Radiat Oncol

Specialty Oncology

Date 2019 Nov 2

PMID 31673657

Citations 1

Authors

Hannah M Dahn

Patricia A K Oliver

Stefan Allen

Amanda Cherpak

Alasdair Syme

Nikhilesh Patil

David Bowes

Affiliations

Soon will be listed here.

Abstract

Purpose: High-dose-rate brachytherapy (HDR-BT) is commonly combined with external beam radiation therapy (EBRT) for the treatment of localized prostate cancer. Escalating the HDR-BT dose as far as organ-at-risk (OAR) constraints allow, on a personalized basis, would allow for a reduction in EBRT dose while achieving similar total biologic equivalence. The primary objective of this study was to determine the dosimetric feasibility of escalating the HDR-BT dose from 15 Gy to 16 or 17 Gy while continuing to meet OAR constraints from the original 15 Gy plan on an individualized basis.

Methods And Materials: A total of 53 consecutive HDR-BT plans were retrospectively assessed to determine what percentage of plans could be reoptimized to deliver a dose of 16 Gy or 17 Gy, while meeting defined 15-Gy OAR constraints. Factors independently associated with dose escalation were examined.

Results: Thirty-nine plans (74%) and 2 plans (4%) were successfully escalated to a dose of 16 Gy and 17 Gy, respectively. Rectum V80 and urethra D were independently predictive of the ability to dose escalate to 16 Gy.

Conclusions: Individualized HDR-BT dose escalation beyond 15 Gy without compromising OAR constraints is dosimetrically feasible. This approach could allow for a corresponding reduction of EBRT fractions (ie, from 15 to 12 fractions) and would be beneficial in terms of resource savings for departments, convenience for patients, and potentially better tolerance of treatment with the expected reduction in biologically equivalent doses to OARs. A clinical trial is being developed to investigate the efficacy and tolerance of personalized HDR-BT/EBRT dose fractionation for localized intracapsular prostate cancer.

Citing Articles

Overview of treatment plan quality in a high dose rate prostate brachytherapy workflow.

Panetta J, Veltchev I, Horwitz E, Hallman M, Wong K, Price R Brachytherapy. 2024; 23(6):698-704.

PMID: 39343653 PMC: 11585429. DOI: 10.1016/j.brachy.2024.08.255.

References

Morton G, Chung H, McGuffin M, Helou J, DAlimonte L, Ravi A . Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: Early toxicity and quality-of life results from a randomized phase II clinical trial of one fraction of 19Gy or two fractions of 13.5Gy. Radiother Oncol. 2016; 122(1):87-92. DOI: 10.1016/j.radonc.2016.10.019. View

Lauche O, Delouya G, Taussky D, Menard C, Beliveau-Nadeau D, Hervieux Y . Single-fraction high-dose-rate brachytherapy using real-time transrectal ultrasound based planning in combination with external beam radiotherapy for prostate cancer: dosimetrics and early clinical results. J Contemp Brachytherapy. 2016; 8(2):104-9. PMC: 4873550. DOI: 10.5114/jcb.2016.59216. View

Smith G, Pickles T, Crook J, Martin A, Vigneault E, Cury F . Brachytherapy improves biochemical failure-free survival in low- and intermediate-risk prostate cancer compared with conventionally fractionated external beam radiation therapy: a propensity score matched analysis. Int J Radiat Oncol Biol Phys. 2015; 91(3):505-16. DOI: 10.1016/j.ijrobp.2014.11.018. View

Mendez L, Morton G . High dose-rate brachytherapy in the treatment of prostate cancer. Transl Androl Urol. 2018; 7(3):357-370. PMC: 6043748. DOI: 10.21037/tau.2017.12.08. View

Vigneault E, Mbodji K, Magnan S, Despres P, Lavallee M, Aubin S . High-dose-rate brachytherapy boost for prostate cancer treatment: Different combinations of hypofractionated regimens and clinical outcomes. Radiother Oncol. 2017; 124(1):49-55. DOI: 10.1016/j.radonc.2017.06.012. View

Morton G, Loblaw D, Sankreacha R, Deabreu A, Zhang L, Mamedov A . Single-fraction high-dose-rate brachytherapy and hypofractionated external beam radiotherapy for men with intermediate-risk prostate cancer: analysis of short- and medium-term toxicity and quality of life. Int J Radiat Oncol Biol Phys. 2009; 77(3):811-7. DOI: 10.1016/j.ijrobp.2009.05.054. View

Kishan A, Shaikh T, Wang P, Reiter R, Said J, Raghavan G . Clinical Outcomes for Patients with Gleason Score 9-10 Prostate Adenocarcinoma Treated With Radiotherapy or Radical Prostatectomy: A Multi-institutional Comparative Analysis. Eur Urol. 2016; 71(5):766-773. PMC: 10262972. DOI: 10.1016/j.eururo.2016.06.046. View

Crook J . Prostate cancer: Elective pelvic nodal radiotherapy: is the jury still out?. Nat Rev Urol. 2015; 13(1):10-1. DOI: 10.1038/nrurol.2015.283. View

Prada P, Cardenal J, Garcia Blanco A, Anchuelo J, Ferri M, Fernandez G . High-dose-rate interstitial brachytherapy as monotherapy in one fraction for the treatment of favorable stage prostate cancer: Toxicity and long-term biochemical results. Radiother Oncol. 2016; 119(3):411-6. DOI: 10.1016/j.radonc.2016.04.006. View

10.

Gomez-Iturriaga A, Casquero F, Pijoan J, Minguez P, Espinosa J, Irasarri A . Health-related-quality-of-life and toxicity after single fraction 19 Gy high-dose-rate prostate brachytherapy: Phase II trial. Radiother Oncol. 2017; 126(2):278-282. DOI: 10.1016/j.radonc.2017.10.039. View

11.

Hoskin P, Motohashi K, Bownes P, Bryant L, Ostler P . High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial. Radiother Oncol. 2007; 84(2):114-20. DOI: 10.1016/j.radonc.2007.04.011. View

12.

Falk A, Demontoy S, Chamorey E, Chand M, Gautier M, Azria D . High-dose-rate brachytherapy boost for prostate cancer: Comparison of three different fractionation schemes. Brachytherapy. 2017; 16(5):993-999. DOI: 10.1016/j.brachy.2017.06.013. View

13.

Shahid N, Loblaw A, Chung H, Cheung P, Szumacher E, Danjoux C . Long-term Toxicity and Health-related Quality of Life after Single-fraction High Dose Rate Brachytherapy Boost and Hypofractionated External Beam Radiotherapy for Intermediate-risk Prostate Cancer. Clin Oncol (R Coll Radiol). 2017; 29(7):412-420. DOI: 10.1016/j.clon.2017.01.042. View

14.

Reis Ferreira M, Khan A, Thomas K, Truelove L, McNair H, Gao A . Phase 1/2 Dose-Escalation Study of the Use of Intensity Modulated Radiation Therapy to Treat the Prostate and Pelvic Nodes in Patients With Prostate Cancer. Int J Radiat Oncol Biol Phys. 2017; 99(5):1234-1242. PMC: 5697895. DOI: 10.1016/j.ijrobp.2017.07.041. View

15.

Krauss D, Ye H, Martinez A, Mitchell B, Sebastian E, Limbacher A . Favorable Preliminary Outcomes for Men With Low- and Intermediate-risk Prostate Cancer Treated With 19-Gy Single-fraction High-dose-rate Brachytherapy. Int J Radiat Oncol Biol Phys. 2016; 97(1):98-106. DOI: 10.1016/j.ijrobp.2016.08.011. View

16.

Siddiqui Z, Gustafson G, Ye H, Martinez A, Mitchell B, Sebastian E . Five-Year Outcomes of a Single-Institution Prospective Trial of 19-Gy Single-Fraction High-Dose-Rate Brachytherapy for Low- and Intermediate-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys. 2019; 104(5):1038-1044. DOI: 10.1016/j.ijrobp.2019.02.010. View

17.

Helou J, DAlimonte L, Loblaw A, Chung H, Cheung P, Szumacher E . High dose-rate brachytherapy boost for intermediate risk prostate cancer: Long-term outcomes of two different treatment schedules and early biochemical predictors of success. Radiother Oncol. 2015; 115(1):84-9. DOI: 10.1016/j.radonc.2015.02.023. View

18.

Spratt D, Zumsteg Z, Ghadjar P, Kollmeier M, Pei X, Cohen G . Comparison of high-dose (86.4 Gy) IMRT vs combined brachytherapy plus IMRT for intermediate-risk prostate cancer. BJU Int. 2014; 114(3):360-7. DOI: 10.1111/bju.12514. View

19.

Fowler J . The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol. 1989; 62(740):679-94. DOI: 10.1259/0007-1285-62-740-679. View

20.

Dearnaley D, Griffin C, Lewis R, Mayles P, Mayles H, Naismith O . Toxicity and Patient-Reported Outcomes of a Phase 2 Randomized Trial of Prostate and Pelvic Lymph Node Versus Prostate only Radiotherapy in Advanced Localised Prostate Cancer (PIVOTAL). Int J Radiat Oncol Biol Phys. 2018; 103(3):605-617. PMC: 6361768. DOI: 10.1016/j.ijrobp.2018.10.003. View