Feasibility of MRI Targeted Single Fraction HDR Brachytherapy for Localized Prostate Carcinoma: ProFocAL-study

Overview

Journal J Cancer Res Clin Oncol

Specialty Oncology

Date 2022 Nov 29

PMID 36445477

Authors

Peter Hass

Frank Fischbach

Maciej Pech

Ahmed Gawish

Affiliations

Soon will be listed here.

Abstract

Purpose: A potential method for focal therapy in locally advanced prostate cancer is focal brachytherapy (F-BT). The purpose of this research was to evaluate midterm F-BT oncologic, functional, and toxicological results in men who had therapy for prostate cancer.

Materials And Methods: Between 2016 and 2020, F-BT was used to treat 37 patients with low- to intermediate-risk prostate cancer. The recommended dosage was 20 Gy. Failure was defined as the existence of any prostate cancer that has persisted in-field after treatment. The F-BT oncologic and functional outcomes served as the main and secondary objectives, respectively.

Results: A median 20-month follow-up (range 14-48 months). 37 patients received F-BT and enrolled in the study; no patient experienced a biochemical recurrence in the first 24 months, according to Phoenix criteria. In the control biopsies, only 6 patients showed in-field failure. The median initial IPSS was 6.5, at 6 months was 6.0, and at 24 months was 5.0. When the median ICIQ-SF score was 0 at the baseline, it remained 0 at 6-, 12-, and 24 months. Overall survival and biochemical disease-free survival after 3 years were all at 100% and 86.4%, respectively. There was no notable acute gastro-intestinal (GI) or genitourinary (GU) adverse effects. No intraoperative or perioperative complications occurred.

Conclusions: For selected patients with low- or intermediate-risk localized prostate cancer, F-BT is a safe and effective therapy.

References

Ahmed H, Dickinson L, Charman S, Weir S, McCartan N, Hindley R . Focal Ablation Targeted to the Index Lesion in Multifocal Localised Prostate Cancer: a Prospective Development Study. Eur Urol. 2015; 68(6):927-36. DOI: 10.1016/j.eururo.2015.01.030. View

Chargari C, Deutsch E, Blanchard P, Gouy S, Martelli H, Guerin F . Brachytherapy: An overview for clinicians. CA Cancer J Clin. 2019; 69(5):386-401. DOI: 10.3322/caac.21578. View

Crook J, Patil N, Ma C, McLean M, Borg J . Magnetic resonance imaging-defined treatment margins in iodine-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2009; 77(4):1079-84. DOI: 10.1016/j.ijrobp.2009.06.040. View

Demanes D, Ghilezan M . High-dose-rate brachytherapy as monotherapy for prostate cancer. Brachytherapy. 2014; 13(6):529-41. DOI: 10.1016/j.brachy.2014.03.002. View

Fischbach F, Hass P, Schindele D, Genseke P, Geisendorf L, Stehning C . MRI targeted single fraction HDR Brachytherapy for localized Prostate Carcinoma: a feasibility study of focal radiation therapy (ProFocAL). Eur Radiol. 2019; 30(4):2072-2081. DOI: 10.1007/s00330-019-06505-0. View

Hauswald H, Kamrava M, Fallon J, Wang P, Park S, Van T . High-Dose-Rate Monotherapy for Localized Prostate Cancer: 10-Year Results. Int J Radiat Oncol Biol Phys. 2015; 94(4):667-74. DOI: 10.1016/j.ijrobp.2015.07.2290. View

Hoskin P, Rojas A, Ostler P, Hughes R, Alonzi R, Lowe G . Single-dose high-dose-rate brachytherapy compared to two and three fractions for locally advanced prostate cancer. Radiother Oncol. 2017; 124(1):56-60. DOI: 10.1016/j.radonc.2017.06.014. View

Laing R, Franklin A, Uribe J, Horton A, Uribe-Lewis S, Langley S . Hemi-gland focal low dose rate prostate brachytherapy: An analysis of dosimetric outcomes. Radiother Oncol. 2016; 121(2):310-315. DOI: 10.1016/j.radonc.2016.09.014. View

10.

Mavroidis P, Milickovic N, Cruz W, Tselis N, Karabis A, Stathakis S . Comparison of different fractionation schedules toward a single fraction in high-dose-rate brachytherapy as monotherapy for low-risk prostate cancer using 3-dimensional radiobiological models. Int J Radiat Oncol Biol Phys. 2013; 88(1):216-23. DOI: 10.1016/j.ijrobp.2013.10.016. View

11.

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

12.

Nguyen P, Chen M, Zhang Y, Tempany C, Cormack R, Beard C . Updated results of magnetic resonance imaging guided partial prostate brachytherapy for favorable risk prostate cancer: implications for focal therapy. J Urol. 2012; 188(4):1151-6. PMC: 3744091. DOI: 10.1016/j.juro.2012.06.010. View

13.

Osoba D, Rodrigues G, Myles J, Zee B, Pater J . Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998; 16(1):139-44. DOI: 10.1200/JCO.1998.16.1.139. View

14.

Peters M, van Son M, Moerland M, Kerkmeijer L, Eppinga W, Meijer R . MRI-Guided Ultrafocal HDR Brachytherapy for Localized Prostate Cancer: Median 4-Year Results of a feasibility study. Int J Radiat Oncol Biol Phys. 2019; 104(5):1045-1053. DOI: 10.1016/j.ijrobp.2019.03.032. View

15.

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

16.

Prada P . Author's response. Brachytherapy. 2019; 18(3):426. DOI: 10.1016/j.brachy.2019.01.010. View

17.

Prada P, Cardenal J, Garcia Blanco A, Andreescu J, Ferri M, Anchuelo J . Focal high-dose-rate brachytherapy for localized prostate cancer: toxicity and preliminary biochemical results. Strahlenther Onkol. 2020; 196(3):222-228. DOI: 10.1007/s00066-019-01561-3. View

18.

Roeloffzen E, Battermann J, van Deursen M, Monninkhof E, Visscher M, Moerland M . Influence of dose on risk of acute urinary retention after iodine-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2010; 80(4):1072-9. DOI: 10.1016/j.ijrobp.2010.03.009. View

19.

Sivaraman A, Barret E . Focal Therapy for Prostate Cancer: An "À la Carte" Approach. Eur Urol. 2016; 69(6):973-5. DOI: 10.1016/j.eururo.2015.12.015. View

20.

Stone N, Stock R . Complications following permanent prostate brachytherapy. Eur Urol. 2002; 41(4):427-33. DOI: 10.1016/s0302-2838(02)00019-2. View

21.

Strouthos I, Tselis N, Chatzikonstantinou G, Butt S, Baltas D, Bon D . High dose rate brachytherapy as monotherapy for localised prostate cancer. Radiother Oncol. 2017; 126(2):270-277. DOI: 10.1016/j.radonc.2017.09.038. View