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Purpose To analyze the efficacy of a protocol-based brachytherapy (BT) boost after external beam radiation therapy (EBRT) with simultaneous chemotherapy in patients with anal carcinoma. Methods and Materials About 190 patients have been analyzed. Around 143 patients were identified with a good clinical response at the end of EBRT. Another 47 patients received an additional BT boost to the residual tumor at 6 weeks after end of chemoradiation. Results The 5-year incidence of local recurrence was 24% in patients with BT boost and 19% in patients without BT boost (p = 0.238). The 5-year disease-free survival rate, overall survival rate, and colostomy-free survival rate were 64% and 75% and 76.1% in the BT group and 69% (p = 0.212), 72% (p = 0.924), and 82.7% (p = 0.488) in the non-BT group. We found no differences in late toxicity between the groups. Conclusions For patients with anal cancer with not a good response to 50–59 Gy EBRT with simultaneous chemotherapy, the further dose escalation using the BT boost up to a mean of 67.5 Gy seems to improve the clinical outcome to the same level as observed in patients with a good response to ERBT, without an increase in late side effects.

first half of the study period (2004-2006), and this decreased to 22% during the latter half of the study period (2007-2009). The odds ratio for utilization of brachytherapy by year (continuous variable) was 0.86 (p#0.001). On UVA, OS was significantly shorter with low median income, Medicare insurance, increasing comorbidity score, and treatment with EBRT alone. Five-year OS was 84%, 88%, and 89% for the EBRT alone, brachytherapy alone, and EBRTþbrachy groups, respectively (Figure 1). On MVA, high median income, low comorbidity score, and treatment with brachytherapy alone (HR 0.66, p50.004) or EBRTþbrachy (HR 0.69, p#0.001) remained associated with longer OS. PSM groups were well-balanced for all patientand disease-specific factors between treatment groups, and Cox proportional hazard analysis of PSM groups confirmed longer OS associated with both brachytherapy alone (HR 0.60, p50.004) and EBRTþbrachytherapy (HR 0.68, p50.002) relative to EBRT alone. Conclusions: Of those men with Gleason score 8 prostate cancer as their only high-risk factor treated with ADT, longer overall survival was achieved when prostate brachytherapy was included, whether utilized alone or in combination with supplemental EBRT. The proportion of men receiving brachytherapy as a component of care continues to decrease significantly in the United States. Further investigation of prostate brachytherapy monotherapy for select high-risk patients is warranted.

26% (220) high-risk. Biochemical failure occurred in 7.7% (66) of patients overall and 4.2% (9), 5.5% (23) and 15.5% (34) of low-, intermediate-, and high-risk group patients. PSA progression-free survival significantly differed according to risk group (log rank test, p!.0001). By 8 years, PSA progression-free survival was 95% for low-risk patients, 87% for intermediate-risk patients, and 63% for high-risk patients. On multivariate analysis, intermediate-risk patients had a 1.5-fold risk (95%CI 0.7-3.3, p50.3) and high-risk patients had a 4-fold increased risk (95%CI 1.9-8.6, p!.001) of PSA progression compared with low-risk patients.