1. Hypofractionated Boost With High-Dose-Rate Brachytherapy and Open Magnetic Resonance Imaging–Guided Implants for Locally Aggressive Prostate Cancer: A Sequential Dose-Escalation Pilot Study
- Author
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Youri Popowski, Raymond Miralbell, Sabine Bieri, Giovanna Dipasquale, Haleem G. Khan, C. Ares, Philippe Nouet, Michel Rouzaud, Orhan Özsoy, and Sandro Pampallona
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Brachytherapy ,Population ,Perineural invasion ,Urology ,Pilot Projects ,Magnetic Resonance Imaging, Interventional ,Disease-Free Survival ,Prostate cancer ,medicine ,Humans ,Neoplasm Invasiveness ,Radiology, Nuclear Medicine and imaging ,education ,Neoadjuvant therapy ,Aged ,education.field_of_study ,Radiation ,business.industry ,Prostate ,Dose fractionation ,Prostatic Neoplasms ,Androgen Antagonists ,Middle Aged ,Prostate-Specific Antigen ,Iridium Radioisotopes ,Urination Disorders ,medicine.disease ,Neoadjuvant Therapy ,Radiation therapy ,Prostate-specific antigen ,Oncology ,Feasibility Studies ,Dose Fractionation, Radiation ,Radiotherapy, Conformal ,Nuclear medicine ,business - Abstract
Purpose To evaluate the feasibility, tolerance, and preliminary outcome of an open MRI-guided prostate partial-volume high-dose-rate brachytherapy (HDR-BT) schedule in a group of selected patients with nonmetastatic, locally aggressive prostatic tumors. Methods and Materials After conventional fractionated three-dimensional conformal external radiotherapy to 64–64.4 Gy, 77 patients with nonmetastatic, locally aggressive ( e.g., perineural invasion and/or Gleason score 8–10) prostate cancer were treated from June 2000 to August 2004, with HDR-BT using temporary open MRI-guided 192 Ir implants, to escalate the dose in the boost region. Nineteen, 21, and 37 patients were sequentially treated with 2 fractions of 6 Gy, 7 Gy, and 8 Gy each, respectively. Neoadjuvant androgen deprivation was given to 62 patients for 6–24 months. Acute and late toxicity were scored according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scoring system. Results All 77 patients completed treatment as planned. Only 2 patients presented with Grade ≥3 acute urinary toxicity. The 3-year probability of Grade ≥2 late urinary and low gastrointestinal toxicity–free survival was 91.4% ± 3.4% and 94.4% ± 2.7%, respectively. Rates of 3-year biochemical disease-free survival (bDFS) and disease-specific survival were 87.1% ± 4.1% and 100%, respectively. Conclusions Boosting a partial volume of the prostate with hypofractionated HDR-BT for aggressive prostate cancer was feasible and showed limited long-term toxicity, which compared favorably with other dose-escalation methods in the literature. Preliminary bDFS was encouraging if one considers the negatively selected population of high-risk patients in this study.
- Published
- 2009