Combined HDR Brachytherapy Research Articles

MR-Guided HDR Brachytherapy Boost in Localized Prostate Cancer - Results of a Phase II Trial.

Dose escalation in localized prostate cancer using brachytherapy combined with external beam radiation (EBRT) has demonstrated improved biochemical control compared to EBRT alone. However, ultrasound guided LDR brachytherapy might be associated with increased GU toxicity. We report the results of a prospective study of MR-guided HDR brachytherapy (MRgHDR) in combination with EBRT for localized prostate cancer. Intermediate- (IR) and high-risk (HR) prostate cancer patients were eligible. Patients received either 15Gy single fraction or 10Gy x 2 fractions using MRgHDR technique, followed by EBRT (37.5 Gy, [prostate only] -IR or 45-46 Gy - [prostate + pelvic nodes] -HR). Toxicity (CTCAE v4) and HRQoL (EPIC) were recorded at 1, 3 and 6 months, then at 1, 2, 3, and 5 years. Androgen deprivation therapy (ADT) was used according to the appropriate disease risk category. Biochemical failure was defined according to Phoenix definition (nadir+2). From 2010-2018, 120 patients were enrolled, 53 (44%) had IR and 67 (56%) had HR disease. Median age was 69 years (range, 46-78), median PSA was 12.1 ng/ml (3.2-148). ADT was used in 84 (70%) of patients, of whom 51 (60%) patients received <1 year and 33 (40%) received >1 year of ADT. A single fraction of 15Gy was given to 94 patients (78%) and the remaining 26 patients (22%) received 10Gy x 2 fractions. EBRT dose was 37.5Gy in 52 (43%) patients while 67 (56%) received 45-46Gy. One patient received only the first fraction of 10Gy, declined the second fraction and subsequently received 60Gy EBRT to the prostate. The median follow up was 58 months (11-134). Overall, 5-year biochemical control was 90% while it was 95% and 86% for IR and HR, respectively. At 5 years 7% patient had nodal or distant relapse or both. While the 5-yr distant control rates were 95% and 91% in the IR, HR, respectively. Acute grade ≥2 GU and GI toxicity was 6.7% and 5% respectively. Acute toxicity trended back to baseline by 6 months in all patients except one. Late grade ≥ 2 GU and GI worst toxicity was seen in 10% and 4.2%, respectively. As with acute toxicity, late toxicity tended to improve over time. Only one patient experienced severe toxicity (Grade 3 GU - frequency) at 6 months but subsequently this resolved. HRQol will be reported separately. MRgHDR brachytherapy boost in conjunction with EBRT provides comparable biochemical outcomes compared to the literature. Severe toxicity rates were minimal. Further follow-up will determine if these outcomes are sustained.

Recent results of HDR brachytherapy in the treatment of localized forms of prostate cancer

Background. High levels of prostate cancer incidence require the search for more effective therapy methods. Interstitial brachytherapy is widely used in the treatment of localized prostate cancer. Purpose – to evaluate the current possibilities of HDR brachytherapy using a 60CO source during radiation therapy in treatment of localized prostate cancer. Materials and Methods. 47 patients with stage II–III prostate cancer who received HDR brachytherapy in combination with EBRT (43 patients) or in mono-mode (4 patients) were examined. The low-risk group included 2 patients (4,3%), the moderate-risk group consisted of 25 patients (53,2%), and the high-risk group included 20 patients (42,5%). The initial mean PSA level was 12,9 ng/ml. The volume of the prostate varied from 17,8 to 57 cm3, the average value was 38,4 cm3. In most patients, the tumor size corresponded to T2 (55,3%). Histologically tumors in all cases corresponded to adenocarcinoma. Results. Evaluation of surgical complications showed: macrohematuria – in 23,4% of cases, acute urethritis – in 6,4% of cases, obstruction symptom – in 4,3%. PSA levels were assessed at 2 months after radiation treatment. The tumor marker ranged from 0,07 to 7,81 ng/ml, the average PSA value was 1,79 ng/ml. MRI examination after 3 months showed that regression of tumor foci and reduction of prostate size was observed in (88,8 ± 6,1)% of patients in the low and intermediate risk groups and in (65,0 ± 10,6)% of cases in the high risk group. After combined radiation treatment: dysuric phenomena of the 1st–2nd grade (RTOG) was diagnosed in 16 patients (37,2%), radiation rectitis of the 1st grade was observed in 4 patients (9,3%). A temporary decrease in sexual function was reported in 2 patients (4,2%). 83% of patients overcame the two-year recurrence-free period: (95,7 ± 3,9)% of patients in the low and intermediate risk groups and in (70,0 ± 10,2)% cases in the high risk group Conclusions. Conducting HDR brachytherapy in terms of combined radiation therapy in patients with localized prostate cancer makes it possible to deliver higher doses of radiation to the tumor volume without the increase in radiation toxicity

Feasibility of aponeurectomy in combination with perioperative 192Ir high dose rate brachytherapy for Dupuytren’s disease

Partial aponeurectomy (PA) is astandard procedure for Dupuytren's contracture (DC). Here we report anovel approach using surgery combined with perioperative high dose rate (192Ir-HDR) brachytherapy. From March 2018 until February 2020, thirteen rays of 6patients with Dupyutren's contractures underwent PA followed by HDR brachytherapy. After removal of fibrous tissue and mobilization of the tendons, one to three catheters per patient were placed intraoperatively. Immediately after surgery, aplanning computer tomography with 3D-planning was performed. Then 10-12 Gy were given to 0-2 mm from the catheters' surface and the catheters were removed 6-12 h after brachytherapy. No complications were observed. The mean contractures were reduced from 55.4° (standard error SE 19.6) to 15.4° (SE 6.7; p < 0.01). One patient showed progressive fibrosis of anontreated ray during follow-up. HDR brachytherapy in combination with surgery is feasible and harbors the potential for combined modality therapy to reduce relapse rates of advanced or relapsing DC. Controlled studies are warranted to investigate the role of bimodal therapy compared with PA alone.

Commissioning of applicator-guided stereotactic body radiation therapy boost with high-dose-rate brachytherapy for advanced cervical cancer using radiochromic film dosimetry

PurposeTo describe an EBT3 GAFCHROMIC film-based dosimetry method to be used in commissioning of a combined HDR brachytherapy (HDRB) and stereotactic body radiation therapy (SBRT) boost for treatment of advanced cervical cancer involving extensive residual disease after external beam treatment. Methods and MaterialsA cube phantom was designed to firmly fit an intrauterine tandem applicator and EBT3 radiochromic film pieces. A high-risk clinical target volume (CTVHR, Total) was contoured with an extended arm at one side. The HDRB treatment was planned to cover the proximal CTVHR, Total with 7 Gy and the distal volume, referred to as CTVHR, Distal, was planned by SBRT for dose augmentation. After HDRB treatment delivery, SBRT treatment was delivered within 1 hour by image guidance using the applicator geometry. Intentional 1D and 2D misalignments were introduced to evaluate the effect on target volumes. In addition, effect of film reirradiation at different time gaps and dose levels was evaluated. ResultsFilm dosimetric accuracy, with up to 2 hours gap between irradiations, was shown to be unaffected. A 2%/2 mm gamma analysis between measured and planned doses showed agreement of >99%. Misalignments of more than 2 mm between applicator and SBRT isocenter resulted in suboptimal dose-volume histogram affecting mostly D98% and D90% of CTVHR, Distal. ConclusionsVisualizing how target dose-volume metrics are affected by minor misalignments between SBRT and HDRB dose gradients, in light of achievable phantom-based experimental quality assurance level, encourages the clinical applicability of this technique. Radiochromic film was shown to be a valuable tool to commission procedures combining two different treatment planning systems and modalities with varying dose rates and energy ranges.

Combined HDR Brachytherapy and External Beam Radiotherapy Vs External Beam Radiotherapy Alone By IMRT in Localized Prostate Cancer; Interim Analysis of Acute Genitourinary and Gastrointestinal Toxicity and Biological Dose Volume Parameters From a Prospective Randomized Control Trial

Combined HDR Brachytherapy and External Beam Radiotherapy Vs External Beam Radiotherapy Alone By IMRT in Localized Prostate Cancer; Interim Analysis of Acute Genitourinary and Gastrointestinal Toxicity and Biological Dose Volume Parameters From a Prospective Randomized Control Trial

Follow-Up Analysis of Combined HDR-Brachytherapy and External Beam Radiotherapy for Prostate Cancer Patients

Follow-Up Analysis of Combined HDR-Brachytherapy and External Beam Radiotherapy for Prostate Cancer Patients

PO-1040: Follow-up analysis of combined HDR-brachytherapy and external beam radiotherapy for prostate cancer patients

PO-1040: Follow-up analysis of combined HDR-brachytherapy and external beam radiotherapy for prostate cancer patients

Combined HDR brachytherapy boost plus external beam radiotherapy by IMRT versus external beam radiotherapy alone IMRT in intermediate- and high-risk prostate cancer: Dosimetric analysis from a randomized control trial.

134 Background: Dose escalation by IMRT or brachytherapy significantly improves biochemical control in localized prostate cancer. In this prospective randomized study we compared dose conformity between two modalities HDR brachytherapy and IMRT to deliver a boost to the prostate after External beam Radiotherapy (EBRT). Methods: 20 patients with localized prostate cancer were randomized to receive IMRT alone or IMRT plus brachytherapy. After randomization, all patients received EBRT 45Gy/25#/5 weeks by IMRT in phase I. In phase II patients received either HDR brachytherapy 19Gy/2# (Arm A) or EBRT 29Gy/15#/3weeks (Arm B) and EQD2–DVH parameters were calculated for comparison. EQD2 was calculated with α/β ratio of 1.5Gy and 3Gy for prostate &amp; 3Gy for rectum and bladder. Results: The median age, stage distribution, Gleason score, PSA and prostate volume of the cohort were 69.5 years, T2b–T3b, 7, 38.5ng/ml and 47.4cc respectively.The HDR BT delivered higher mean doses to PTV. In phase II, HDR BT vs IMRT the mean EQD2 for 95% of prostate volume, 33% of rectal volume was 45.7Gy vs 28.4Gy, 6.8Gy vs 17.4 Gy respectively; Dmean of rectum and bladder was 7.4 Gy vs 13.5Gy and 5.4Gy vs 12.7Gy respectively. Conclusions: HDR BT produced more conformal plan and lower OAR doses than IMRT. Dose escalation for prostate tumors by HDR BT may be preferred as easily achievable. [Table: see text]

Additional androgen deprivation makes the difference

The role of additional androgen deprivation therapy (ADT) in prostate cancer (PCa) patients treated with combined HDR brachytherapy (HDR-BT) and external beam radiotherapy (EBRT) is still unknown. Consecutive PCa patients classified as D'Amico intermediate and high-risk who underwent HDR-BT and EBRT treatment ± ADT at our institution between January 1999 and February 2009 were assessed. Multivariable Cox regression models predicting biochemical recurrence (BCR) were performed. BCR-free survival was assessed with Kaplan-Meier analyses. Overall, 392 patients were assessable. Of these, 221 (56.4 %) underwent trimodality (HDR-BT and EBRT and ADT) and 171 (43.6 %) bimodality (HDR-BT and EBRT) treatment. Additional ADT administration reduced the risk of BCR (HR: 0.4, 95 % CI: 0.3-0.7, p < 0.001). D'Amico high-risk patients had superior BCR-free survival when additional ADT was administered (log-rank p < 0.001). No significant difference for BCR-free survival was recorded when additional ADT was administered to D'Amico intermediate-risk patients (log-rank p = 0.2). Additional ADT administration improves biochemical control in D'Amico high-risk patients when HDR-BT and EBRT are combined. Physicians should consider the oncological benefit of ADT administration for these patients during the decision-making process.

Outcome of 6 fractions of 5.3 Gray HDR brachytherapy in combination with external beam radiotherapy for treatment of cervical cancer

ObjectiveTo review the characteristics, outcomes and toxicities of cervical cancer patients treated with 6 fractions of brachytherapy after external beam radiotherapy (EBRT). MethodsAll patients diagnosed with cervical cancer from 2000 to 2009 who were referred for radical treatment and who received 6 fractions of brachytherapy were retrospectively reviewed. Overall survival (OS), disease free survival (DFS), local control (LC), distant control (DC) rate, acute and late toxicities were the primary endpoints. ResultsThirty-two patients with mainly advanced stage squamous cell carcinoma were identified and reviewed. Patients received EBRT of 45 to 50.4Gy in 1.8Gy daily fractions followed by 6 sessions of 3 channel brachytherapy of 5.3Gy prescribed to point H. Response rates to treatment were good, with no residual disease in 84% six weeks after the completion of treatment. With a median follow up time of 8.1years, the five-year OS, DFS, LC and distant control rates were 75%, 68.5%, 92.8% and 76.9% respectively. None of the patients developed any G3-4 acute toxicity but one patient who had advanced disease developed G3-4 proctitis with a fistula formation. ConclusionsHDR brachytherapy utilizing 6 fractions of 5.3Gy prescribed to point H with concurrent chemo-radiation is superior in terms of OS and LC to regimens that deliver a lower EQD2 dose to point A/H and is associated with very low rates of toxicities.

Predictors of distant metastasis after combined HDR brachytherapy and external beam radiation for prostate cancer

PurposeTo determine predictors of distant metastases (DM) in prostate cancer patients treated with high dose rate brachytherapy boost (HDR-B) and external beam radiation therapy (EBRT).Material and methodsFrom 1991 to 2002, 768 men with localized prostate cancer were treated with HDR-B and EBRT. The mean EBRT dose was 37.5 Gy (range: 30.6-45 Gy), and the HDR-B was 22 or 24 Gy delivered in 4 fractions. Univariate and multivariate analyses using a Cox proportional hazards model including age at diagnosis, T stage, Gleason score (GS), pretreatment PSA, biologically equivalent dose (BED), and use of androgen deprivation therapy (ADT) was used to determine predictors of developing distant metastases.ResultsThe median follow-up time for the entire patient population was 4.2 years (range: 1-11.2 years). Distant metastases were identified in 22/768 (3%) of patients at a median of 4.1 years. PSA failure according to the Phoenix definition developed in 3%, 5%, and 14% of men with low, intermediate, and high risk disease with a median time to failure of 3.8 years. Prostate cancer specific mortality was observed in 2% of cases. T stage, GS, and use of ADT were significantly associated with developing DM on univariate analysis. GS, and use of ADT were the only factors significantly associated with developing DM on multivariate analysis (p < 0.01). Patients who received ADT had significantly higher risk features suggesting patient selection bias for higher DM in this group of patients rather than a negative interaction between HDR-B and EBRT.ConclusionsIn men treated with HDR-B and EBRT, GS is a significant factor on multivariate analysis for developing distant metastasis.

Interstitial HDR brachytherapy (HDR-BT) in early stage mobile tongue cancers in young patients - Gliwice experience.

PurposeIn early stage mobile tongue cancer radical radiotherapy offers good local control and organ preservation, which is especially important in the group of young patients. In our department, for many years HDR-BT has been performed in mobile tongue cancers as a sole treatment or as a “boost” with EBRT. The aim of the study was to show our experience with HDR-BT in early stage mobile tongue cancers among young patients.Material and methodsFrom 2001 to 2006 in Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, five patients under 45 years with mobile tongue cancer were treated with HDR brachytherapy (T1N0M0 – 3/5 and T2N0M0 – 2/5); 4 with HDR brachytherapy “boost” and 1 as a sole treatment. One woman was previously treated with tumour resection, but because of positive surgical margins was referred for radiotherapy. All patients had clinically negative lymph nodes, without dissection. They were treated with interstitial HDR-BT (3-8 catheters). In 4 patients treated with HDR-BT as a “boost”, total doses ranged from 18 to 21 Gy given in 6-7 fractions (twice a day, 3 Gy per fraction). Total doses in EBRT (to local lymph nodes and tumour bed) ranged from 50 to 60 Gy (1.8-2 Gy per fraction 5 days/week). One patient, treated with radical HDR brachytherapy, received 45 Gy in 10 fractions and 50 Gy in EBRT to regional lymph nodes.ResultsWe did not notice local recurrences or distant metastases in our group of patients. Median follow-up was 67 months (range 47-79 months). All patients preserved normal tongue function. A severe late complication occurred in 1 patient – fracture of the mandible.ConclusionsIn the analysed group of young patients with mobile tongue cancer interstitial HDR brachytherapy in combination with EBRT was an effective and well tolerated treatment modality which allowed preservation of the tongue and its function.

94 poster: HDR Brachytherapy in Combination With EBR in Prostate Cancer Patients

94 poster: HDR Brachytherapy in Combination With EBR in Prostate Cancer Patients

Outpatient HDR brachytherapy in combination with IMRT and IGRT ± ADT in the treatment of low-, intermediate-, and high-risk prostate cancer

Outpatient HDR brachytherapy in combination with IMRT and IGRT ± ADT in the treatment of low-, intermediate-, and high-risk prostate cancer

High-dose-rate-Brachytherapie beim Risikoprostatakarzinom

To estimate disease-free survival it is necessary to allocate patients into tumor risk groups: locally advanced prostate carcinoma with extracapsular spread or localized prostate carcinoma of tumor stage T2c or one of the risk factors PSA >20 or Gleason > or =8 apply for the high-risk group. Intermediate-risk carcinomas are those belonging to tumor stage T2b or with PSA >10-20 or Gleason 7. Particularly for patients with intermediate and high-risk disease early PSA relapse is of major interest. This phenomenon could be a consequence of current inadequate imaging of lymph node or bone metastasis or as a consequence subclinical metastatic spread remains undetectable during radical treatment. However, tumor biology itself could lead to the progression of the disease in the high-risk group. As a consequence, risk-adapted therapy is very important in these cases. The applied radiation dose plays an important role in radiotherapy. Several publications have shown that the biochemical relapse correlates with the generally accepted risk factors and the radiation dose. Regarding this, high-quality treatment planning and HDR brachytherapy combined with EBRT (external beam radiation therapy) leads to good treatment results in selected groups. So far in our own experience, HDR brachytherapy in combination with EBRT is a successful form of treatment with few acute and late side effects in the first 42 patients examined. First results concerning to PSA relapse-free time, quality of life, miction, and erectile function are promising.

Combined HDR Brachytherapy and Online Image-Guided Adaptive IMRT for Dose Escalation in Locally Advanced Carcinoma of the Prostate

Purpose/Objective: The positive outcome of RTOG 9413 and new imaging procedures for noninvasive pelvic lymph node (PLN) staging have increased interest in dose-escalation strategies for intermediate-risk prostate cancer that address treatment of primary as well as nodal gross tumor volumes (GTVs). Single-fraction high dose-rate interstitial brachytherapy (HIB) is an attractive option because no planning target volume (PTV) margin is needed to assure accurate delivery and large dose fractions are well tolerated.

Feasibility and preliminary outcome of salvage combined HDR brachytherapy and external beam radiotherapy (EBRT) for local recurrences after radical prostatectomy

Purpose Feasibility of combined fractionated intensity modulated brachytherapy (IMBT) and external beam radiotherapy (EBRT) as well as the effect of local dose escalation was investigated in a non-randomized retrospective observation trial for histologically-proven macroscopic local recurrences of prostate cancer after radical prostatectomy. Methods and materials Thirty-five patients with transrectal ultrasound (TRUS) detectable tumors were treated. Applied dose per IMBT fraction was 15 Gy, prescribed on the target (TRUS visible tumor) surface. For the first 21 patients, two fractions of IMBT were delivered in 2 weeks interval, complementary to 30 Gy EBRT to the small pelvis. Further, as second step of dose escalation, 14 patients were treated with 2 × 15 Gy IMBT combined with 40 Gy EBRT. The total treatment time was 4 and 5 weeks, respectively. Results PSA was decreased in 34 out of 35 patients post-therapeutically. After a mean follow-up of 27 months, 32 out of 35 patients are alive. However, in 67% of the patients, we observed postimplant PSA elevation with or without detectable local and/or systemic progress. The mean duration of biochemical non-evidence of disease (bNED) after radiation was 12 months for all patients (31% in the 30 Gy group and 42% in the 40 Gy group). No RTOG/EORTC grade III or IV side effects were registered during/after radiotherapy. Conclusion Combined EBRT and IMBT-boost of TRUS detectable recurrences of prostate cancer after radical prostatectomy seems to be a feasible method of salvage treatment. These early results need to be confirmed by further prospective randomized trials and by longer follow-up in all dose groups.

Curative radiotherapy of localized prostate cancer. Treatment methods and results

Radiation oncology has undergone rapid technical development during the last few years. The further development of treatment planning systems and treatment machines had a major impact on the improvement of radiation therapy results in prostate cancer. This paper presents different treatment modalities and results. Currently available are three-dimensional conformal radiation, intensity modulated radiation therapy (IMRT), high dose rate brachytherapy, and low dose rate brachytherapy (seed implantation). All modalities offer the possibility for dose escalation, which is essential for curative treatment. Dose escalation using these techniques makes it possible to reduce the dose for the surrounding organs at risk. Three-dimensional conformal radiation therapy can be delivered with doses up to 78 Gy. The biochemical control rate is up to 90% depending on the risk factors T stage, initial PSA, and Gleason score. The incidence of late side effects is <10%. IMRT is a newer modality for percutaneous radiotherapy. By individual dose modification in the treatment fields, doses >80 Gy can be delivered in small treatment volumes. Treatment has to be highly precise to avoid dose peaks in the organs at risk, i.e., rectum and bladder. The preliminary data for remission and toxicity rates are promising, but it is too early for final conclusions. For cases with high-risk factors such as PSA >10 ng/ml, Gleason score >6, and stage T3, percutaneous radiation can be combined with neoadjuvant or adjuvant hormonal treatment. Randomized trials showed an improvement of the results in favor of combined treatment. HDR brachytherapy in combination with external radiation is a good option for dose escalation in patients with locally advanced tumors and/or other high-risk factors. The biochemical control rates are between 60 and 84%, late effects occur in less than 10%. Seed implantation (LDR brachytherapy) as sole treatment is indicated for prognostically favorable situations (PSA <10 ng/ml, Gleason score < or =6, and T1c or T2a tumors). The biochemical control rates are between 80 and 90%. Toxicity consists of urine retention and proctitis, occurring in 10-20% of the patients.

High Dose Rate Brachytherapy is Safe and Effective in Patients with Self-Expandable Metal Stents Placed for Endobronchial Tumor

Background: HDR Brachytherapy is an established tumor ablative technique for endobronchial lung cancer. However, recently, endobronchial metallic stents have been increasingly employed in this patient population. Possibly metallic stents might alter radiation distribution and cause over or underdosage to tumor and normal tissue. We prospectively examined the use of HDR combined with metallic stents in terms of safety and efficacy. Methods: A total of 21 consecutive HDR procedures on 7 patients with known symptomatic endobronchial malignancy were evaluated. Initially a metallic stent (Nitinol Accuflex Stent, Boston Scientific Co.) was placed and expanded at bronchoscopy. At this procedure an endobronchial HDR catheter was then introduced. Immediately thereafter an HDR procedure delivered 500–700 cGy to 1 cm depth. Two additional HDR procedures followed 1 week apart. Bronchoscopic evaluation of the stent and response took place at each HDR procedure and 1 week as well as at least 1 month post the last HDR treatment. Results: All patients tolerated the bronchoscopies, stent placement and HDR Brachytherapy without complication. No hemoptysis, pulmonary degredation, stent movement or clinical evidence of overdosage/underdosage to tumor or nearby normal tissue was clinically evident at any follow-up bronchoscopy. At one month post the last HDR no clinical or radiographic evidence of stent-HDR radiation interaction was seen. Uniform tumor ablation in the treated field was also noted. All patients achieved pulmonary palliation. Conclusion: HDR Brachytherapy in combination with metal stents is effective and without undue morbidity. The stents re-expansion of the airway offers rapid pulmonary palliation and makes optimal HDR catheter placement easier, which may well improve dose homogeneaty. After stenting, the catheters can be precisely placed under direct visualization rather than by the blind procedure required when tumor is completely obstructing the airway.

Prostate preservation by combined external beam and HDR brachytherapy in nodal negative prostate cancer.

The combined external beam- and high-dose rate brachytherapy (HDR-BT) of localized prostate cancer was introduced at Kiel University in 1986. The aim of this intermediate analysis was to judge the Kiel method of localized prostate cancer radiation treatment after ten years experience. In the past ten years 174 patients with histological proven localized prostate cancer were subjected to combined tele-/HDR-brachytherapy. Local staging in all of the cases by transrectal ultrasound, nodal staging in the majority of the cases by CT or MRI. Average age of the patients was 68.2 years (44-84). According to AJCC/UICC staging T1B, T2, T3 was found in 2, 113 and 59 cases, respectively. Highly differentiated tumors (G1) were found in 27, moderately differentiated (G2) in 87, poorly differentiated (G3) in 60 cases. The mean follow-up was 47.1 months with the median of 51.7 months. Total prescribed dose 50 Gy on the small pelvis and 70 Gy on the prostate capsule due to the integration of two, 15 Gy each, HDR-brachytherapy fractions in 6 weeks. Ten patients died of prostate cancer and 18 of intercurrent diseases resulting in a 5 years overall survival rate of 83% and tumor specific survival rate of 94%. Twenty-one patients showed a clinical progression, of these 14 systemic, 5 local and 2 both systemic and local. Additional 16 patients had PSA elevation only. The 5-years biochemical and/or clinical progression-free survival in the cohort was 79% and 73% for the T3 tumors. Side effects were 27 cases of proctitis/colitis and 20 cases of dysuria/cystitis. The integrated HDR-BT combined with external beam radiation treatment is a method with excellent tumor control rates at five years superior to those of external beam treatment alone or external beam combined with iodine-125 implants. This form of radiotherapy would appear to be particularly well-suited to treatment of advanced localized (T3) tumors.