Rate Brachytherapy For Prostate Cancer Research Articles

Needle Migration in High Dose Rate Brachytherapy for Prostate Cancer Evaluated by Serial MRI and Photos

Needle Migration in High Dose Rate Brachytherapy for Prostate Cancer Evaluated by Serial MRI and Photos

Efficacy and Feasibility of Low-Dose Rate Brachytherapy for Prostate Cancer in Renal Transplant Recipients

BackgroundIn young patients with localized prostate cancer, radical prostatectomy is the treatment of choice in the general population. Radiotherapy, such as low-dose rate (LDR) brachytherapy or intensity-modulated radiotherapy, is a viable alternative as well. However, in transplant patients, irradiation is not proposed as often as it is in healthy adults because of the risk of post-radiation ureteral stenosis and gastrointestinal toxicity as the result of fragile tissue. The objective of the study was to assess the efficacy and feasibility of LDR brachytherapy for prostate cancer in renal transplant recipients (RTRs). MethodsBetween May 2007 and December 2014, all patients who had undergone LDR brachytherapy for clinically localized prostate cancer at our institution were retrospectively identified (n = 203). Of these patients, 2 had a history of renal transplantation. We reviewed all available clinical data retrospectively. One patient had a functioning graft and the other had re-started hemodialysis 7 years after the transplantation. ResultsThe mean time from renal transplantation to prostate cancer diagnosis was 16 years. The mean follow-up after seed implantation was 45 months. There were no peri-operative complications after seed implantation. The 2 patients remained free of prostate-specific antigen progression during the follow-up period. The renal function of the patient with a functioning graft, as measured by serum creatinine, was stable during and after the operation. ConclusionsLDR brachytherapy is technically feasible and acceptable as a minimally invasive treatment in carefully selected RTRs with localized prostate cancer. This treatment should be considered a suitable option for RTRs with localized prostate cancer.

High dose rate brachytherapy for prostate cancer: Standard of care and future direction

High dose rate brachytherapy for prostate cancer: Standard of care and future direction

High dose rate brachytherapy for prostate cancer: Standard of care and future direction

High dose rate brachytherapy for prostate cancer: Standard of care and future direction

High dose rate brachytherapy for prostate cancer: Standard of care and future direction

High dose rate brachytherapy is a highly conformal method of radiation dose escalation for prostate cancer and one of several treatment options for men with localised disease. The large doses per fraction exploit the low alpha/beta ratio of prostate cancer cells so that biological radiation dose delivered is substantially greater than that achieved with conventional external beam delivery. This review article presents contemporary data on the rationale for high dose rate brachytherapy including treatment technique and future directions.

Trainee Involvement Does Not Impact Outcomes in Low Dose Rate Brachytherapy for Prostate Cancer

Trainee Involvement Does Not Impact Outcomes in Low Dose Rate Brachytherapy for Prostate Cancer

High Dose Rate Brachytherapy for Prostate Cancer

High Dose Rate Brachytherapy for Prostate Cancer

EP-1255: Learning curve of MRI guided high dose rate brachytherapy for prostate cancer

EP-1255: Learning curve of MRI guided high dose rate brachytherapy for prostate cancer

DuraSeal® as a spacer to reduce rectal doses in low-dose rate brachytherapy for prostate cancer

The purpose of this study was to evaluate the utility of off-label use of DuraSeal® polyethylene glycol (PEG) gel in low-dose rate (LDR) prostate brachytherapy seed implantation to reduce rectal doses. Diluted DuraSeal® was easy to use and, in spite of a clearance effect, useful in decreasing D2cc rectal doses.

Low dose rate brachytherapy for prostate cancer at the Cleveland Clinic: A technical review

Low dose rate brachytherapy for prostate cancer at the Cleveland Clinic: A technical review

Prospective longitudinal comparative study of health-related quality of life and treatment satisfaction in patients treated with hormone therapy, radical retropubic prostatectomy, and high or low dose rate brachytherapy for prostate cancer

Purpose:To evaluate the effects of four different prostate cancer treatments on quality of life (QoL) and patient satisfaction.Methods:Ninety-six prostate cancer patients were treated with hormone therapy, radical retropubic prostatectomy, high dose rate brachytherapy, or low dose rate brachytherapy. We assessed general, cancer-specific, and prostate disease-specific QoL. More than one year since commencement of treatment, the patients were asked the following questions: 1) How do you feel about your treatment? 2) Would you undergo the same treatment again?Results:The comparison of baseline and 12-month results showed that general and cancer-specific QoL had changed little in all groups. At baseline, the general and cancer-specific QoL tended to be lower in the hormone therapy patients. In the radical the retropubic prostatectomy patients, all scores on the Medical Outcomes Study 36-Item Short Form were worse than the baseline scores at three months. Scores for the International Index of Erectile Function-5 had also worsened, with no recovery. In the low-dose rate brachytherapy patients, the prostate disease-specific QoL at baseline tended to improve. However, the satisfaction levels for each treatment were reasonably good, and most patients would choose the same treatment again.Conclusions:The results of each of the four treatments differed in assessments of QoL. In the radical retropubic prostatectomy patients, the decrease in the International Index of Erectile Function-5 scores was especially remarkable and did not show recovery. In contrast, both brachy therapy groups had attained superior sexual function. However, regardless of the quality of life evaluations, most patients surveyed were satisfied with their treatments and would choose the same treatment again.

Report of a consensus meeting on focal low dose rate brachytherapy for prostate cancer.

What's known on the subject? and What does the study add? Whole gland brachytherapy has been used to successfully treat prostate cancer but the protocol for focal therapy has not previously been established. The consensus findings provide guidance on patient selection for focal brachytherapy as well as recommendations for conducting therapy and patient follow-up. Low dose rate prostate brachytherapy is an effective treatment for localized prostate cancer. Recently, it has been considered for use in a focused manner whereby treatment is targeted only to areas of prostate cancer. The objective of focal brachytherapy is to provide effective cancer control for low-risk disease but with reduced genitourinary and rectal side-effects in a cost-effective way. We report on the outputs of a consensus meeting of international experts in brachytherapy and focal therapy convened to consider the feasibility and potential development of focal brachytherapy. A number of factors were considered for focal brachytherapy including optimal patient selection, disease characterization and localization, treatment protocols and outcome measures. The consensus meeting also addressed the design of a clinical trial that would assess the oncological outcomes and side-effect profiles resulting from focal brachytherapy.

Long‐term toxicity and quality of life up to 10 years after low‐dose rate brachytherapy for prostate cancer

To report on the long-term toxicity outcome for patients with prostate cancer treated by low-dose rate (LDR) brachytherapy (BXT). The study population comprised a cohort of men treated in our centre between March 1999 and April 2004 with LDR BXT for prostate cancer who had at least 5 years of follow-up post-implant. Patients who had died or experienced biochemical failure were excluded. We contacted eligible patients and asked them to complete a questionnaire to assess current urinary, erectile and bowel function. Urinary and erectile function was compared pre- and post-treatment and outcomes were assessed by treatment modality. Of the 226 LDR BXT-treated patients with >5 years of follow-up, 174 (77.0%) responded to the questionnaire. The mean International Prostate Symptom Score (IPSS) increased from 6.70 pre-BXT to 7.91 at follow-up (P = 0.003). Of the patients with mild symptoms pre-BXT (IPSS, 0-7), 64.2% retained mild symptoms at follow-up, 31.2% developed moderate symptoms (IPSS, 8-9) and 4.6% reported severe symptoms (IPSS, 20-35). A good or acceptable quality of life (QoL) secondary to urinary symptoms (IPSS QoL, 0-4) was reported by 98.0% of respondents. Of those patients potent (International Index of Erectile Function-5 ≥11) pre-BXT, 62.9% remained potent at follow-up. There were no differences in the proportion of patients who were potent when analyzed by the number of years post-implant. At follow-up, 51.7% and 45.4% of patients, respectively, had normal or mild bowel symptoms as indicated by the European Organisation for the Research and Treatment of Cancer questionnaire (QLQ-C30/PR25 scores, 4-8). Moderate bowel symptoms (QLQ-C30/PR25 scores, 9-12) were reported by 2.9% of respondents; none reported severe symptoms. The present study shows low morbidity after LDR BXT over the long-term for a large cohort of patients.

Low Dose Rate Brachytherapy for Prostate Cancer at the Northamptonshire Centre for Oncology — Outcomes and Bounces

Introduction: Patients with prostate cancer have been treated with low dose rate (LDR) I125 brachytherapy at the Northamptonshire Centre for Oncology since 2002. We evaluated biochemical relapse according to the Phoenix definition (nadir PSA +2 ng/ml) [1] and assessed the occurrence of PSA bounce. A PSA bounce is a rise and subsequent fall in PSA of more than 0.2 ng/ml. This is a recognised phenomenon and may lead to a mistaken diagnosis of relapse [2].

Analysis of the Temporal Sequence of Selected Long-term Toxicities for Patients Treated with Brachytherapy or Brachytherapy Plus External Beam Radiation for Prostate Adenocarcinoma

Differential timing of specific long-term toxicities for patients treated with brachytherapy are reported for cervical cancer. We assessed the temporal sequence of selected long-term side effects including dysuria, rectal bleeding, hematuria, and erectile dysfunction for patients treated with low dose rate brachytherapy for prostate cancer. Patients definitively treated for prostate adenocarcinoma at Mt. Sinai Medical Center from 1990-2007 who received either a full I-125 or Pd-103 implant or a partial Pd-103 implant followed by external beam radiation were selected from our database. Patients with less than 2 years of follow-up and salvage implants were excluded. Two thousand forty-seven patients met inclusion criteria. Median follow-up was 5.8 years (range 2-17.8). Patients were selected for a documented report of dysuria of any grade (N = 483), grade 2 rectal bleeding excluding hemorrhoids (N = 92), hematuria of any grade excluding bleeding immediately following the implant (N = 168), and erectile dysfunction as defined as a drop in the Mt. Sinai Erectile Function score from a value of 2 or 3 to 1 or 0 (N = 368). For erectile dysfunction, patients who received any hormonal therapy were excluded (N = 920). Values are reported as the time from implant until the first incident of the toxicity. Kaplan-Meier survival curves were generated to determine the time for the toxicity to occur in 25%, 50%, and 75% of patients who experienced that particular toxicity. Cox-Regression was done for multivariate analysis. With regard to dysuria, the time elapsed for the onset of symptoms in 25%, 50%, and 75% of patient who experienced dysuria was 0.5, 1.1, and 2.3 years, respectively. Time to first onset of symptoms for 25%, 50%, and 75% of patients who experienced grade 2 rectal bleeding was 1.3, 2.1, and 3.1 years, respectively. For hematuria, time to first onset for 25%, 50%, and 75% of patients who experienced the symptom was 2.0, 4.1, and 8.3 years, respectively. Finally, time to the first onset of erectile dysfunction for patients who did not receive hormonal therapy was 0.6, 3.2, and 8.2 years for 25%, 50%, and 75% of the patients who experienced these symptoms. Multivariate analysis for all toxicities found no association in timing of the symptoms with regard to BED, Age, or Risk Group of the patient. Unique patterns of time to first onset of selected toxicities were observed in patients who received a radioactive implant for prostate adenocarcinoma. While dysuria and rectal bleeding occur rapidly and early, hematuria and erectile dysfunction tend to be slightly delayed in first onset and more variable in the overall distribution of first events. Patients might be educated accordingly.

Development of Late Toxicity and International Prostate Symptom Score Resolution After External-Beam Radiotherapy Combined With Pulsed Dose Rate Brachytherapy for Prostate Cancer

To investigate the development of gastrointestinal (GI) toxicity, genitourinary (GU) toxicity, erectile dysfunction, and International Prostate Symptom Score (IPSS) resolution in a cohort of patients treated with external-beam radiotherapy (EBRT) followed by a brachytherapy pulsed dose rate (PDR) boost. Between 2002 and 2008, 110 patients were treated with 46-Gy EBRT followed by PDR brachytherapy (24.96-28.80 Gy). The investigated outcome variables, GI toxicity, GU toxicity, erectile dysfunction, and IPSS were prospectively scored at several time points during follow-up. Association between time (as continuous and categorical variable) and the outcome variables was assessed using generalized linear models. No statistically significant association was found between time (continuous) and GI toxicity (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.89-1.06), GU toxicity (OR, 0.97; 95% CI, 0.91-1.03), erectile dysfunction (OR, 1.06; 95% CI, 0.99-1.11), and IPSS (-0.11; 95% CI, -0.41-0.20). Also, no statistically significant association was found between these variables and time as a categorical variable. GU toxicity was associated with IPSS resolution (OR, 1.16; 95% CI, 1.09-1.24). Posttreatment IPSS was associated with pretreatment IPSS (0.52; 95% CI, 0.25-0.79). No accumulation of high-grade toxicity over time could be established for a group of patients treated with EBRT and PDR brachytherapy for prostate cancer, probably because high-grade late toxicity resolves with time. Also, differences in IPSS values among patients are smaller after treatment than before treatment.

Previous transurethral resection of the prostate is not a contraindication to high‐dose rate brachytherapy for prostate cancer

To analyse retrospectively the morbidity and efficacy of high-dose rate (HDR) brachytherapy in patients who had a previous transurethral resection of the prostate (TURP). Morbidities documented in the records of 32 patients with previous TURP and 106 with no previous TURP, treated with HDR brachytherapy for prostate cancer at our institution, were analysed and compared. All patients received HDR brachytherapy as a boost before conformal external beam radiotherapy. We recorded and analysed genitourinary complications, rectal morbidity, and the biochemical control rate as assessed by the prostate-specific antigen (PSA) level. All complications of patients who received HDR brachytherapy were recorded during the follow-up. All gastrointestinal and genitourinary complications were not significantly different in patients with or without previous TURP. There was little incontinence or severe morbidity associated with HDR brachytherapy. The PSA-based biochemical control rates were similar in patients with or without previous TURP in each risk group. HDR brachytherapy is a reasonable treatment for localized prostate cancer in patients who have had a previous TURP, with the expectation of low morbidity and satisfactory biochemical control.

High Dose Rate and External Beam Radiotherapy in Locally Advanced Prostate Cancer

To report the outcomes and toxicity of high dose rate brachytherapy as a boost for localized prostate cancer. Between 1997 and 2000, the medical records of 131 patients with prostate adenocarcinoma who were treated with external beam radiation therapy and high dose rate brachytherapy, were retrospectively analyzed. Furthermore, 55% of the patients received neoadjuvant/concurrent or adjuvant androgen deprivation therapy. Patients were stratified into 2 groups. Group 1 included 65 patients with Gleason score 7, pretreatment prostate specific antigen (PSA) between 10 and 20 ng/mL, and clinical stage T2b. Group 2 included 66 patients with Gleason score between 8 and 10, PSA greater than 20 ng/mL, and clinical stage greater than T2b. At a median follow-up of 62.8 months, the 5-year biochemical control (BC) rate, as defined by the American Society for Therapeutic Radiology and Oncology Phoenix Consensus panel statement, was 81% and overall survival was 91%. BC in Groups 1 and 2 were 87% and 71%, respectively. On univariate analysis risk group, pretreatment PSA and age were significant predictors of BC. However, on multivariate analysis only pretreatment PSA was significant. Using the Radiation therapist oncology group criteria, there were 2 (1.5%) cases of grade 3 acute urinary toxicity. Regarding late side effects (n = 5), 4% of patients had grade 3 genitourinary toxicity and no grade 4 complication was observed. External beam radiation therapy and high dose rate brachytherapy for prostate cancer resulted in excellent BC, and overall survival with minimal severe, acute, or late complications.

Urethral stricture following high dose rate brachytherapy for prostate cancer

Purpose To evaluate the incidence, timing, nature and outcome of urethral strictures following high dose rate brachytherapy (HDRB) for prostate carcinoma. Methods and materials Data from 474 patients with clinically localised prostate cancer treated with HDRB were analysed. Ninety percent received HDRB as a boost to external beam radiotherapy (HDRBB) and the remainder as monotherapy (HDRBM). Urethral strictures were graded according to the Common Terminology Criteria for Adverse Events v3.0. Results At a median follow-up of 41 months, 38 patients (8%) were diagnosed with a urethral stricture (6-year actuarial risk 12%). Stricture location was bulbo-membranous (BM) urethra in 92.1%. The overall actuarial rate of grade 2 or more BM urethral stricture was estimated at 10.8% (95% CI 7.0–14.9%), with a median time to diagnosis of 22 months (range 10–68 months). All strictures were initially managed with either dilatation ( n = 15) or optical urethrotomy ( n = 20). Second line therapy was required in 17 cases (49%), third line in three cases (9%) and 1 patient open urethroplasty (grade 3 toxicity). Predictive factors on multivariate analysis were prior trans-urethral resection of prostate (hazard ratio (HR) 2.81, 95% CI 1.15–6.85, p = 0.023); hypertension (HR 2.83, 95% CI 1.37–5.85, p = 0.005); and dose per fraction used in HDR (HR for 1 Gy increase per fraction 1.33, 95% CI 1.08–1.64, p = 0.008). Conclusions BM urethral strictures are the most common late grade 2 or more urinary toxicity following HDR brachytherapy for prostate cancer. Most are manageable with minimally invasive procedures. Both clinical and dosimetric factors appear to influence the risk of stricture formation.

High dose rate brachytherapy for prostate cancer

High dose rate (HDR) afterloading brachytherapy in the management of localised prostate cancer has practical, physical and biological advantages over low dose rate seed brachytherapy. There are no free live sources used, no risk of source loss and since the implant is a temporary procedure following discharge no issues with regard to radioprotection use of existing facilities. Adequate coverage of extracapsular and seminal vesicle tumour is possible for advanced cases and HDR brachytherapy is the most efficient means of obtaining dose escalation in terms of biological dose based on a low α/β ratio. Selection for HDR brachytherapy includes patients with any prostate specific antigen (PSA) level provided there is no demonstrable metastasis, any Gleason score and stages T1B to T3B. The results of a randomised trial show that HDR brachytherapy is an effective means of dose escalation with a favourable therapeutic ratio when compared with standard external beam radiotherapy. Current studies are evaluating HDR brachytherapy as monotherapy delivering a radical dose in two to four fractions. The acute toxicity with HDR brachytherapy is short-lived and far less severe than seen with low dose rate brachytherapy and late toxicity rates are low.