High-dose-rate brachytherapy administered in a single treatment may be a safe and effective alternative for patients with non-metastatic prostate cancer, according to a new study.
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Brachytherapy is typically administered over the course of 4 to 9 treatment sessions. While the number of sessions can be streamlined by increasing the dose given in each session, only limited data exists on the safety and tolerability of highly escalated brachytherapy because the strategy is relatively new.
Daniel J Krauss, MD, radiation oncologist, Oakland University (Michigan), and colleagues conducted a non-randomized, prospective clinical trial to assess the safety and efficacy of a single, high-dose of brachytherapy administered to men with low- or intermediate-risk prostate cancer. A total of 58 patients received a single 19 Gy fraction of high-dose-rate brachytherapy. Ninety-one percent of the patients presented with stage T1 disease. Results of the trial were published in the International Journal of Radiation Oncology (January 1, 2017;97[1]:98-106).
Researchers found that after an average of approximately 3 years following treatment, prostate cancer control rates were favorable and the toxicity profile was highly favorable. Only 3 patients demonstrated recurrence or progression, resulting in an estimated 3-year cumulative biochemical control rate of 93%. Within the 6 months following high-dose-rate brachytherapy, approximately 12% of patients experienced grade 2 urinary side effects and no patients experienced short-term grade 3 urinary toxicity or grade 2 gastrointestinal toxicity.
Modest rates were also observed for long-term side effects. Approximately 10.3% of patients experienced chronic grade 2 urinary toxicity and 1.7% of patients experienced grade 3 chronic gastrointestinal toxicity that were subsequently resolved. No patients experienced long-term grade 3 urinary toxicity or grade 4 gastrointestinal toxicity.
"Giving the entire dose in a single treatment theoretically could have had a greater negative impact on the normal tissues in close proximity to the prostate -- meaning the bladder, urethra and rectum -- but this was not found to be the case. Toxicity rates were extremely low, with essentially no major complications encountered in this initial group of 58 patients," said Dr Krauss (ScienceDaily, March 1, 2017).
Researchers highlight the need for additional follow-up to compare long-term cancer control rates with conventional treatment approaches, which tend to administer larger doses than those used in the trial. – Zachary Bessette
