Abstract
PurposeThis study’s objective was the comparison of external beam radiotherapy (EBRT) and I‑125 seed brachytherapy regarding clinical outcome and development of side effects.Patients and methodsIn all, 462 localized intermediate-risk prostate cancer patients treated between 2000 and 2019 at our department using either I‑125 seed brachytherapy or EBRT with a dose of 74 or 78 Gy were included: 297 patients were treated with EBRT and 165 with seeds. Biochemical no evidence of disease (bNED) rates according to Phoenix definition as well as late gastrointestinal and urogenital side effects (EORTC/RTOG) were assessed.ResultsPatients were followed up yearly with a median follow-up of 54 (3–192) months. Observed bNED rates for 74 Gy, 78 Gy and seeds were 87, 92, and 88% after 5 years and 71, 85, and 76% after 9 years, respectively. No significant differences were found comparing seeds with 74 Gy (p = 0.81) and 78 Gy (p = 0.19), as well as between 74 and 78 Gy (p = 0.32). Concerning gastrointestinal side effects, EBRT showed significantly higher rates of RTOG grade ≥ 2 toxicity compared to seeds, but at no point of the follow-up more than 10% of all patients. However, genitourinary side effects were significantly more prevalent in patients treated with seeds, with 33% RTOG grade ≥ 2 toxicity 12 months after treatment. Nevertheless, both types of side effects decreased over time.ConclusionFavorable intermediate-risk prostate cancer patients can be treated either by external beam radiotherapy (74/78 Gy) or permanent interstitial seed brachytherapy.
Highlights
Localized primary prostate cancer can be treated via external beam radiotherapy (EBRT) or permanent interstitial seed brachytherapy (BT)
We report the results concerning biochemical no evidence of disease as well as late gastrointestinal und genitourinary side effects, as increased Biochemical no evidence of disease (bNED) rates shift the focus on side effects
All patients included were treated at our Department of Radiation Oncology and had to meet the following inclusion criteria: Intermediate-risk primary prostate cancer as defined by the NCCN classification [13]: Prostate-specific antigen (PSA) between 10 and 20 ng/ml, or Gleason score 7, or a TNM stage of T2b or T2c, Favorable intermediate risk: only one or two risk factors regarding T-stage, PSA or Gleason score, Localized cancer with a clinical stage of cNx/0 and cMx/0, Primary treatment locally limited to the prostate, and EBRT patients treated from 2000 to 2015 and I-125 seed BT patients treated from 2004–2019
Summary
Localized primary prostate cancer can be treated via external beam radiotherapy (EBRT) or permanent interstitial seed brachytherapy (BT). Both of these treatment modalities achieve excellent tumor control rates [1,2,3]. The recommendations and guidelines consider these modalities as equivalent especially for patients with low-risk prostate cancer [1, 2]. For intermediate-risk patients this strict recommendation to perform seeds BT is missing [1]. Numerous studies evaluating the tumor control rates K
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