Favorable Preliminary Outcomes for Men with Low- and Intermediate-Risk Prostate Cancer Treated with 19 Gy Single Fraction High-Dose-Rate Brachytherapy
Mené sur 58 patients atteints d'un cancer de la prostate à risque faible ou intermédiaire de récidive (âge médian : 61,4 ans ; durée médiane de suivi : 2,9 ans), cet essai met en évidence la tolérabilité et l'efficacité, du point de vue du contrôle de la maladie et de l'échec biochimique, d'une dose de rayonnements ionisants (19 Gy) délivrée en une seule fraction par curiethérapie à haut débit de dose
Purpose : To report toxicity and preliminary clinical outcomes of a prospective trial evaluating 19 Gy single fraction high-dose-rate (HDR) brachytherapy for men with low- and intermediate-risk prostate cancer. Materials and Methods : 63 patients were treated according to an IRB-approved prospective study of single fraction HDR brachytherapy. Eligible patients had tumor stage < T2a, PSA < 15, and Gleason score < 7. Patients with prostate gland volume > 50 cc and baseline American Urologic Association (AUA) symptom score > 12 were ineligible. Patients underwent trans-rectal ultrasound (TRUS)-guided trans-perineal implant of the prostate followed by single fraction HDR brachytherapy. Treatment was delivered via Ir-192 to a dose of 19 Gy prescribed to the prostate with no additional margin applied. Results : 58 patients were available for analysis. Five withdrew consent during the follow-up period. Median follow up was 2.9 years [range 0.3-5.2 years]. Median age was 61.4 years. Median gland volume at the time of treatment was 34.8 cc. 91% of patients had T1 disease, 71% had Gleason score < 6 (29% Gleason 7), and median pre-treatment PSA was 5.1 ng/mL. Acute and chronic grade 2 genitourinary toxicity incidence was 12.1% and 10.3%, respectively. No grade 3 urinary toxicity occurred. No patients experienced acute rectal toxicity > grade 2, and 2 experienced > grade 2 chronic GI toxicity. 3 patients have experienced biochemical failure yielding a 3-year cumulative incidence estimate of 6.8%. Conclusions : Single fraction HDR brachytherapy is well-tolerated with favorable preliminary biochemical and clinical disease control rates.