Abstract
The aim of this paper is to compare outcomes between high-dose-rate interstitial brachytherapy (HDR-BT) monotherapy and image-guided intensity-modulated radiotherapy (IG-IMRT) for localized prostate cancer. We examined 353 HDR-BT and 270 IG-IMRT patients. To reduce background selection bias, we used the method of inverse probability treatment weighting (IPTW) with propensity scores. The actuarial five-year biochemical failure-free survival rates were 92.9% and 96.7% (p = 0.1847; p = 0.077 in IPTW) for HDR-BT and IG-IMRT, respectively; they were 100% and 95.8% (p = 0.286) for the low-risk group, 95.6% and 92% (p = 0.42) for the intermediate-risk group, 90.4% and 84.9% (p = 0.1059; p = 0.04 in IPTW) for the high-risk group, and 87.1% and 89.2% (p = 0.3816) for the very-high-risk group. In the assessment of accumulated incidences of grade ≥ 2 toxicity (Common Terminology Criteria for Adverse Events version 4.0) at five years, HDR-BT monotherapy showed higher genitourinary toxicity (11.9%) than IG-IMRT (3.3%) (p < 0.0001). The gastrointestinal toxicity was equivalent for HDR-BT (2.3%) and IG-IMRT (5.5%) (p = 0.063). No Grade 4 or 5 toxicity was detected in either modality. HDR-BT showed higher genitourinary toxicity than IG-IMRT. HDR-BT and IG-IMRT showed equivalent outcomes in low-, intermediate-, and very-high-risk groups. For high-risk patients, HDR-BT showed potential to improve prostate-specific antigen (PSA) control rate compared to IG-IMRT.
Highlights
Prostate cancer is one of the most prevalent noncutaneous malignancies among men in Western countries, and it has been increasing in incidence in recent decades
high-dose-rate interstitial brachytherapy (HDR-BT) monotherapy-treated patients had lower pretreatment prostate-specific antigen (PSA) levels, lower Gleason scores (GSs) with more hormonal therapy, and longer follow-up periods compared to patients treated with image-guided intensity-modulated radiotherapy (IG-IMRT) tomotherapy
As BT has a higher conformality than external beam radiotherapy (EBRT), it has the potential to improve the therapeutic ratio by allowing higher doses to tumor
Summary
Prostate cancer is one of the most prevalent noncutaneous malignancies among men in Western countries, and it has been increasing in incidence in recent decades. Cancers 2018, 10, 322 are increasing life expectancy, marked presence of the Western lifestyle (high-calorie diet and sedentary lifestyle), and improvement in accurate diagnostic methods. Common treatment options include prostatectomy, external beam radiotherapy (EBRT), and interstitial brachytherapy (BT) [1]. With the advancement of EBRT techniques, image-guided intensity-modulated radiotherapy (IG-IMRT) has become more widely used for prostate cancer. IG-IMRT can reduce normal tissue toxicity compared to three-dimensional conformal radiotherapy (3D-CRT) or even IMRT [2,3,4]. As a result, advanced EBRT is a standard treatment for all stages of localized prostate cancer [1,4]. We used IG-IMRT with helical tomotherapy—with or without hormonal therapy—which enabled precise dose delivery using megavoltage-computed tomography (MVCT) [5,6]
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