20 Prostate Cancer

Prostate Cancer

15

THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY | Part II: Clinical Practice Version 1 - 01/12/2014

Table 21.7: Clinical results of LDR seed brachytherapy

Number of patients

bNED low risk (%)

bNED interm. risk (%)

bNED high risk (%)

Author

Median FU (y)

Tiara et al. 2011 [41] Henry et al. 2010 [42] Hinnen et al. 2009 [43] Stone et al. 2007 [44] Zelefsky et al. 2007 [45] Potters et al. 2005 [46]

12 10 10 10

1656 1298

99 % 72 % 88 % 64% 74 % 88 %

97 % 74 % 61 % 64 % 61 % 76 %

91 % 58 % 30 % 58% 39 % 62 %

921

2293 2693 1148

8

12

Table 21.8: Clinical results of LDR seed brachytherapy combined with external beam radiotherapy.

Number and patient risk group

Author

median f/u

bRFS

Time of bRFS

132 All high risk

Stock (2004) [55]

50mo

86%

5yr

243 119 inter 124 high 223 59 low 50 inter 114 high

Dattoli (2007) [56]

9.5y

87% 72%

14y 14y

85.8% 80.3% 67.8%

15y 15y 15y

Sylvester (2007) [47]

9.4y

199 40 low

Koontz (2009) [57]

4.2y

87%

5y

Table 21.9: Clinical results of temporary HDR brachytherapy

Author

Patients

Dose

Biochemical Relapse Free Survival Risk category

Follow up

Low 91 %

Inter 90 %

High 89 %

Pellizon 2003 [58]

209

4-6Gy x 4 5.5Gy x 2 – 6.5Gy x 4

64mo

Vargas 2006 [59]

197

86 %

69 %

59mo

Phan 2007 [60] Kalkner 2007 [61] Demanes 2009 [62] Zwahlen 2010 [63] Wilder 2010 [64] Kaprealian 2012 [65]

309 154 209 196 284 165

6Gy x 4 10Gy x 2

98 % 97 % 90 % 94 %

90 % 83 % 87 % 83 %

78 % 51 % 69 % 76 % 93 % 89 %

64mo 73mo 84mo 65mo 66mo

5.5-6Gy x 4 4-5Gy x 4

5.5Gy x 4

100 %

100 %

6Gy x3

92 %

79 %

105mo

HDR afterloading brachytherapy HDR boost with external beam radiotherapy

response has been implied in the sequential dose escalation co- horts reported from Michigan in which the boost dose after ex- ternal beam 45Gy in 25 fractions has increased from 16Gy in two fractions to 24Gy in two fractions, improved biochemical relapse free survivals being seen in the high dose group [66]. One of the largest published series is a pooled analysis of patients treated in Michigan, Oakland and Kiel comprising 1577 patients with intermediate or high risk disease who received a median external beam dose of 40Gy and HDR boost of 24Gy [67]. Five and 10 year biochemical control rates were 85% and 82% respectively.

There is an increasing body of literature demonstrating the effi- cacy of HDR boost brachytherapy in single centres. Reports with more than 100 patients and a median follow up of five years or more are shown in table 21.9 [58-65]. Different groups have employed a range of external beam doses and HDR boost schedules so that it is difficult to draw clear con- clusions or recommendations for the optimal approach. A dose