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| IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711 |
Int J Clin Exp Med 2011;4(1):43-52
Original Article
High-dose-rate brachytherapy combined with hypofractionated external beam
radiotherapy for men with intermediate or high risk prostate cancer: analysis of
short- and medium-term urinary toxicity and biochemical control
Antonio Cassio Assis Pellizzon, Ricardo Cesar Fogaroli, Maria Leticia Gobo Silva, Douglas Guedes Castro, Maria Conte Maia, Ademar
Lopes
Radiation Oncology Department – Hospital AC Camargo, São Paulo, Brazil; Radiation Oncology Service - Instituto
Arnaldo Viera de Carvalho, São Paulo, Brazil; Prostate Institute, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil;
Pelvic Surgery Department - Hospital AC Camargo, São Paulo, Brazil.
Received December 7, 2010; accepted December 25, 2010; Epub December 26, 2010; published January 1, 2011
Abstract: Introduction: The best management of localized and locally advanced prostate cancer remains controversial, but there are
evidences that for patients considered of unfavorable outcome dose escalation radiotherapy has a significantly better outcome.
Methods: Between 2005-2009 a total of 39 unfavorable patients were treated in a phase I-II trial for dose escalation with high-dose rate
(HDR)- 30Gy/4 fractions BID/2 implants and hipofractionated conformal/tri-dimensional radiotherapy (hEBRT)-45Gy/3Gy fractions in 3
weeks, at Hospital AC Camargo, Sao Paulo, Brazil. Results: Median age of patients was 69 years old. With a median follow up of 42.5
months the highest RTOG acute and late severe genitourinary toxicity (GU-TX) were grade 3 in 2 patients (5.1%) and 1 (2.6%) patients,
respectively. No predictive clinical or dosimetric factor related to acute GU-TX was found. Regarding late GU-TX, prostate volume > 45cc
(p=0.024), <11 needles per implant (p=0.038) and urethral dose >130% of prescribed dose (p<0,001) were statistical significant
predictive factors. On multivariate analysis the only predictive factor for late GU-TX was urethral dose >130%, p=0.017 (95%CI–1.39-
29.49), HR-6.4. The actuarial overall survival, biochemical control and disease specific survival rates at 3.5-years were 92.0%, 87.6%
and 96.9%, respectively. Conclusion: HDR combined to hEBRT is well tolerated in the short and medium term. Acute toxicity was
minimal and improved outcomes in terms of reduced late toxicity can be achieved using at least 11 needles and prostate volumes up
to 45cc to be implanted. The maximum urethral dose should be kept bellow 130% of prescribed dose. (IJCEM1012004).
Keywords: Prostate cancer, radiotherapy, brachytherapy, toxicity, biochemical control
Full Text PDF
Address all correspondence to:
Dr. Antonio Cassio Assis Pellizzon
Hospital ACCamargo
Rua Prof. Antonio Prudente, 211, Liberdade
São Paulo, Brazil
Tel: 01509-020, Fax: +55-11-21895101
E-mail: acapellizzon@hcancer.org.br
Original Article
High-dose-rate brachytherapy combined with hypofractionated external beam
radiotherapy for men with intermediate or high risk prostate cancer: analysis of
short- and medium-term urinary toxicity and biochemical control
Antonio Cassio Assis Pellizzon, Ricardo Cesar Fogaroli, Maria Leticia Gobo Silva, Douglas Guedes Castro, Maria Conte Maia, Ademar
Lopes
Radiation Oncology Department – Hospital AC Camargo, São Paulo, Brazil; Radiation Oncology Service - Instituto
Arnaldo Viera de Carvalho, São Paulo, Brazil; Prostate Institute, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil;
Pelvic Surgery Department - Hospital AC Camargo, São Paulo, Brazil.
Received December 7, 2010; accepted December 25, 2010; Epub December 26, 2010; published January 1, 2011
Abstract: Introduction: The best management of localized and locally advanced prostate cancer remains controversial, but there are
evidences that for patients considered of unfavorable outcome dose escalation radiotherapy has a significantly better outcome.
Methods: Between 2005-2009 a total of 39 unfavorable patients were treated in a phase I-II trial for dose escalation with high-dose rate
(HDR)- 30Gy/4 fractions BID/2 implants and hipofractionated conformal/tri-dimensional radiotherapy (hEBRT)-45Gy/3Gy fractions in 3
weeks, at Hospital AC Camargo, Sao Paulo, Brazil. Results: Median age of patients was 69 years old. With a median follow up of 42.5
months the highest RTOG acute and late severe genitourinary toxicity (GU-TX) were grade 3 in 2 patients (5.1%) and 1 (2.6%) patients,
respectively. No predictive clinical or dosimetric factor related to acute GU-TX was found. Regarding late GU-TX, prostate volume > 45cc
(p=0.024), <11 needles per implant (p=0.038) and urethral dose >130% of prescribed dose (p<0,001) were statistical significant
predictive factors. On multivariate analysis the only predictive factor for late GU-TX was urethral dose >130%, p=0.017 (95%CI–1.39-
29.49), HR-6.4. The actuarial overall survival, biochemical control and disease specific survival rates at 3.5-years were 92.0%, 87.6%
and 96.9%, respectively. Conclusion: HDR combined to hEBRT is well tolerated in the short and medium term. Acute toxicity was
minimal and improved outcomes in terms of reduced late toxicity can be achieved using at least 11 needles and prostate volumes up
to 45cc to be implanted. The maximum urethral dose should be kept bellow 130% of prescribed dose. (IJCEM1012004).
Keywords: Prostate cancer, radiotherapy, brachytherapy, toxicity, biochemical control
Full Text PDF
Address all correspondence to:
Dr. Antonio Cassio Assis Pellizzon
Hospital ACCamargo
Rua Prof. Antonio Prudente, 211, Liberdade
São Paulo, Brazil
Tel: 01509-020, Fax: +55-11-21895101
E-mail: acapellizzon@hcancer.org.br
