A recent study comparing radiotherapy methods for prostate cancer suggests that physician-reported toxicities may be lower for patients treated with high-dose-rate brachytherapy, and patient-reported outcomes may be worse for those treated with low-dose-rate brachytherapy (Anticancer Res. 2021;41[5]:2523-2531. doi:10.21873/anticanres.15030.)

“Prostate cancer is the most prevalent malignancy in men across all countries. In addition to prostatectomy, radiotherapy is the standard therapeutic option,” wrote Makoto Ito, Department of Radiology, Aichi Medical University Hospital, Nagakute, Japan, and colleagues.

“Although risk stratification is a general treatment strategy, the guidelines have not recommended one radiotherapy technique over another,” they added.

This study aimed to compare five radiotherapy methods for prostate cancer: high-dose-rate brachytherapy; low-dose-rate brachytherapy; or external-beam radiotherapy, including conventionally fractionated radiotherapy, moderate-hypofractionated radiotherapy, and ultra-hypofractionated radiotherapy.

Data from 496 patients treated using one of the forementioned radiotherapy strategies and a follow-up of 4.3 years were retrospectively analyzed. Of these patients, 149 received high-dose-rate brachytherapy, 100 received low-dose-rate brachytherapy, 100 received conventionally fractionated radiotherapy, 97 received moderate-hypofractionated radiotherapy, and 50 received ultra-hypofractionated radiotherapy.

The results for this study showed the incidence of grade ≥2 acute genitourinary toxicities was significantly lower with high-dose-rate brachytherapy (P <.001) than with any other radiotherapy, while the cumulative incidence of late grade ≥2 genitourinary toxicities was the highest with ultra-hypofractionated radiotherapy, and significantly higher (P = .005) with ultra-hypofractionated radiotherapy than with high-dose-rate brachytherapy. Patients receiving low-dose-rate brachytherapy had higher symptom score peaks 4 weeks after therapy compared to patients receiving external-beam radiotherapy.

“Physician-recorded toxicities were slightly lower with HDR-BT [high-dose-rate brachytherapy] and patient-reported outcomes tended to be worse with LDR-BT[low-dose-rate brachytherapy],” the authors concluded.—Marta Rybczynski