Top

Published in:

01-05-2019 | Original Article

Toxicity and risk factors after combined high-dose-rate brachytherapy and external beam radiation therapy in men ≥75 years with localized prostate cancer

Authors: Dr. med. Anastassia Löser, Burkhard Beyer, Cedric Oliver Carl, Benjamin Löser, Yamini Nagaraj, Thorsten Frenzel, Cordula Petersen, Andreas Krüll, Markus Graefen, Rudolf Schwarz

Published in: Strahlentherapie und Onkologie | Issue 5/2019

Abstract

Purpose

Combined high-dose-rate brachytherapy (HDR-BT) and external beam radiation therapy (EBRT) is a favorable treatment option in non-metastatic prostate cancer. However, reports on toxicity and outcome have mainly focused on younger patients. We aimed to determine toxicity and biochemical control rates after combined HDR-BT and EBRT in men ≥75 years.

Methods

From 1999 to 2015, 134 patients aged ≥75 years (median 76 years; 75–82 years) were identified. Patients received 18 Gy of HDR-BT (9 Gy/fraction on days 1 and 8) with an iridium-192 source. After 1 week, supplemental EBRT with a target dose of 50.4 Gy was started (delivered in 1.8 Gy fractions).

Results

Median follow-up time was 25 months (0–127 months). No severe (grade 4) gastrointestinal (GIT) or genitourinary (GUT) toxicities were observed. In 76 patients (56.7%), 3D conformal radiation therapy (CRT) and in 34.3% intensity-modulated radiotherapy (IMRT) was applied. CRT-treated patients were at a 2.17-times higher risk (hazard ratio [HR]: 2.17, 95% confidence interval [CI]: 1.31–3.57, p = 0.002) of experiencing GUT. GIT risks could be reduced by 78% using IMRT (HR: 0.22, 95% CI: 0.07–0.75, p = 0.015). Patients with a higher T stage (T2c–3a/b) were less likely to experience GIT or GUT (HR: 0.49, 95% CI: 0.29–0.85, p = 0.011 and HR: 0.5, 95% CI: 0.3–0.81, p = 0.005, respectively).

Conclusion

HDR-BT/EBRT is a well-tolerated treatment option for elderly men ≥75 years with a limited number of comorbidities and localized intermediate- or high-risk prostate cancer. IMRT should be favored since side effects were significantly reduced in IMRT-treated patients.

Alibhai SMH, Naglie G, Nam R, Trachtenberg J, Krahn MD (2003) Do older men benefit from curative therapy of localized prostate cancer? J Clin Oncol 17:3318–3327CrossRef

Aoki M, Miki K, Kido M, Sasaki H, Nakamura W, Kijima Y, Kobayashi M et al (2014) Analysis of prognostic factors in localized high-risk prostate cancer patients treated with HDR brachytherapy, hypofractionated 3D-CRT and neoadjuvant/adjuvant androgen deprivation therapy (trimodality therapy). J Radiat Res 3:527–532CrossRef

Boehm K, Schiffmann J, Tian Z, Lesmana H, Larcher A, Mandel P, Karakiewicz PI et al (2016) Five-year biochemical recurrence-free and overall survival following high-dose-rate brachytherapy with additional external beam or radical prostatectomy in patients with clinically localized prostate cancer. Urol Oncol 3(119):e11–e18

Cancer Research UK (2016) Prostate cancer incidence statistics. Prostate cancer incidence by age. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/incidence#ref-1. Accessed 14 June 2018

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies. Development and validation. J Chron Dis 5:373–383CrossRef

Cox J, Stetz J, Pajak T (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 5:1341–1346CrossRef

Etzioni R, Penson DF, Legler JM, Di Tommaso D, Boer R, Gann PH, Feuer EJ (2002) Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst 13:981–990CrossRef

Faria S, Ruo R, Cury F, Duclos M, Souhami L (2017) Acute and late toxicity in high-risk prostate cancer patients treated with androgen suppression and hypofractionated pelvic radiation therapy. Pract Radiat Oncol 4:264–269CrossRef

Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H, Forman D et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 6:1374–1403CrossRef

10.

Finazzi T, Guckenberger M (2017) Bildgeführte intensitätsmodulierte Strahlentherapie vermindert die gastrointestinalen Spätfolgen nach Radiotherapie des Prostatakarzinoms (Image-guided intensity-modulated radiation therapy decreases late gastrointestinal side effects after radiation therapy for prostate cancer). Strahlenther Onkol 2:162–164CrossRef

11.

Galalae RM, Martinez A, Nuernberg N, Edmundson G, Gustafson G, Gonzalez J, Kimming B (2006) Hypofractionated conformal HDR brachytherapy in hormone naive men with localized prostate cancer. Is escalation to very high biologically equivalent dose beneficial in all prognostic risk groups? Strahlenther Onkol 3:135–141CrossRef

12.

Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M et al (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 1:124–137CrossRef

13.

Hjalm-Eriksson M, Ullen A, Johansson H, Levitt S, Nilsson S, Kalkner K‑M (2017) Comorbidity as a predictor of overall survival in prostate cancer patients treated with external beam radiotherapy combined with HDR brachytherapy boosts. Acta Oncol 1:21–26CrossRef

14.

Hoskin PJ, Rojas AM, Bownes PJ, Lowe GJ, Ostler PJ, Bryant L (2012) Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer. J Natl Cancer Inst 2:217–222

15.

Kim Y‑J, Cho KH, Pyo HR, Lee KH, Moon SH, Kim TH, Shin KH et al (2015) Radical prostatectomy versus external beam radiotherapy for localized prostate cancer. Comparison of treatment outcomes. Strahlenther Onkol 4:321–329CrossRef

16.

Kotecha R, Yamada Y, Pei X, Kollmeier MA, Cox B, Cohen G’aN, Zaider M et al (2013) Clinical outcomes of high-dose-rate brachytherapy and external beam radiotherapy in the management of clinically localized prostate cancer. Brachytherapy 1:44–49CrossRef

17.

López Torrecilla J, Hervás A, Zapatero A, Gómez Caamaño A, Macías V, Herruzo I, Maldonado X et al (2015) Uroncor consensus statement. Management of biochemical recurrence after radical radiotherapy for prostate cancer: from biochemical failure to castration resistance. Rep Pract Oncol Radiother 4:259–272CrossRef

18.

Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, de Santis M, Fossati N et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1. Screening, diagnosis, and local treatment with curative intent. Eur Urol 4:618–629CrossRef

19.

National Cancer Institute (2018) Surveillance, Epidemiology, and End Results Program Cancer Stat Facts: Prostate Cancer. How Common Is This Cancer? https://seer.cancer.gov/statfacts/html/prost.html. Assessed: 14 June 2018

20.

National Comprehensive Cancer Center Clinical Practice Guidelines in Oncology (2013) Prostate Cancer version 3. http://www.cus.cz/wp-content/uploads/2012/10/NCCN-C61-2014.pdf. Assessed: 14 June 2018

21.

Nutting CM, Convery DJ, Cosgrove VP, Rowbottom C, Padhani AR, Webb S, Dearnaley DP (2000) Reduction of small and large bowel irradiation using an optimized intensity-modulated pelvic radiotherapy technique in patients with prostate cancer. Int J Radiat Oncol Biol Phys 3:649–656CrossRef

22.

Pinkawa M, Fischedick K, Treusacher P, Asadpour B, Gagel B, Piroth MD, Borchers H et al (2006) Dose-volume impact in high-dose-rate Iridium-192 brachytherapy as a boost to external beam radiotherapy for localized prostate cancer—a phase II study. Radiother Oncol 1:41–46CrossRef

23.

Roach M, Hanks G, Jr Thames H, Schellhammer P, Shipley WU, Sokol GH, Sandler H (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 4:965–974CrossRef

24.

Sathya JR, Davis IR, Julian JA, Guo Q, Daya D, Dayes IS, Lukka HR et al (2005) Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 6:1192–1199CrossRef

25.

Scherr D, Swindle PW, Scardino PT (2003) National Comprehensive Cancer Network guidelines for the management of prostate cancer. Urology 2:14–24CrossRef

26.

Schiffmann J, Lesmana H, Tennstedt P, Beyer B, Boehm K, Platz V, Tilki D et al (2015) Additional androgen deprivation makes the difference. Biochemical recurrence-free survival in prostate cancer patients after HDR brachytherapy and external beam radiotherapy. Strahlenther Onkol 4:330–337CrossRef

27.

Soumarova R, Homola L, Perkova H (2012) Long term results of HDR brachytherapy in men older than 75 with localized carcinoma of the prostate. Rep Pract Oncol Radiother 1:11–15

28.

Waldstein C, Dörr W, Pötter R, Widder J, Goldner G (2018) Postoperative Strahlentherapie beim Prostatakarzinom. Morbidität nach lokaler Radiatio vs. lokaler Radiatio und Beckenbestrahlung (Postoperative radiotherapy for prostate cancer: Morbidity of local-only or local-plus-pelvic radiotherapy). Strahlenther Onkol 1:23–30CrossRef

Title: Toxicity and risk factors after combined high-dose-rate brachytherapy and external beam radiation therapy in men ≥75 years with localized prostate cancer
Authors: Dr. med. Anastassia Löser
Burkhard Beyer
Cedric Oliver Carl
Benjamin Löser
Yamini Nagaraj
Thorsten Frenzel
Cordula Petersen
Andreas Krüll
Markus Graefen
Rudolf Schwarz
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 5/2019
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-018-1380-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Toxicity and risk factors after combined high-dose-rate brachytherapy and external beam radiation therapy in men ≥75 years with localized prostate cancer

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2019

Impact of androgen deprivation therapy on apparent diffusion coefficient and T2w MRI for histogram and texture analysis with respect to focal radiotherapy of prostate cancer

Chemoradiotherapy for anal cancer: are we as good as we think?

Einfluss der prophylaktischen Ganzhirnbestrahlung auf das Gesamtüberleben von Patienten mit einem fortgeschrittenen nicht-kleinzelligen Bronchialkarzinom

Beim HPV-assoziierten Oropharynxkarzinom ist die Radiochemotherapie mit Cisplatin der Bioradiotherapie mit Cetuximab in Bezug auf das Gesamtüberleben überlegen

Dosimetric and volumetric effects in clinical target volume and organs at risk during postprostatectomy radiotherapy

The value of pretreatment serum butyrylcholinesterase level as a novel prognostic biomarker in patients with cervical cancer treated with primary (chemo-)radiation therapy