Abstract
Purpose: To overcome radioresistance for patients with unfavorable prostate cancer, a prospective trial of pelvic external beam irradiation (EBRT) interdigitated with dose escalating conformal HDR prostate brachytherapy was performed. We are reporting the outcomes. MaterialsM the high dose was 85% p = 0.001. There was improvement in cause-specific survival in favor of the brachytherapy high dose level p = 0.016. On multivariate analysis, a low dose level, higher Gleason score, shorter time to nadir and higher nadir value were associated with increased biochemical failure. RTOG grade 3 GI/GU complications ranged 0.5–9%. Actuarial 5 yr impotency rate was 52%. Conclusion: EBRT interdigitated with HDR prostate brachytherapy boost is a very effective treatment for unfavorable prostate cancer. We demonstrated an incremental beneficial effect on BC and cause-specific survival with higher doses. These results coupled with the low risk of complications and advantage of not being radioactive post-implant defines a new standard for treatment.
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