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Conformal high dose rate iridium-192 boost brachytherapy in locally advanced prostate cancer: superior prostate-specific antigen response compared with external beam treatment.
Cancer J Sci Am. 1997 Nov-Dec; 3(6):346-52.CJ

Abstract

PURPOSE

Prostate-specific antigen levels are used to judge disease control of prostate cancer. No published data attest to the greater ability of conformal brachytherapy to control disease compared with conventional radiation at a single institution. This report compares the biochemical response rates in patients with stages T2b to T3c prostate cancer treated with conformal brachytherapy boost and external beam radiation with the rates in patients treated with conventional external radiation alone.

MATERIALS AND METHODS

From November 1991 through November 1995, 58 patients received 45.6 Gy pelvic external irradiation and three high dose rate iridium-192 conformal boost implants of 5.5 to 6.5 Gy each. They were compared with 278 similarly staged patients treated from January 1987 through December 1991 with external beam radiation to prostate-only fields (median dose 66.6 Gy). No patient received androgen deprivation. Patient outcome was analyzed for biochemical control. Biochemical failure was defined as a prostate-specific antigen level > 1.5 ng/mL and rising on two consecutive values. If serial posttreatment prostate-specific antigen levels were showing a continuous downward trend, failure was not scored.

RESULTS

Median follow-up was 43 months for the conventionally treated group and 26 months for the brachytherapy boost group. The median pretreatment prostate-specific antigen level was 14.3 ng/mL for the external-beam-radiation-alone group and 14.0 ng/mL for the brachytherapy boost group. The median Gleason scores were 6 and 7, respectively, for the two groups. The biochemical control rate was significantly higher in the brachytherapy boost treatment group. Three-year actuarial biochemical control rates were 85% versus 52% for the conformally and conventionally treated patients, respectively. In a multivariate analysis, the use of conformal brachytherapy boost and pretreatment prostate-specific antigen level were significant prognostic determinants of biochemical control. The 3-year actuarial rates of biochemical control for conformally versus conventionally treated patients, respectively, were 83% versus 72% for a pretreatment prostate-specific antigen level of 4.1 to 10.0 ng/mL, 85% versus 47% for a prostate-specific antigen level of 10.1 to 20.0 ng/mL, and 89% versus 29% for prostate-specific antigen > 20 ng/mL. When the analysis was limited to patients in both groups with a minimum 12-month follow-up, the brachytherapy boost group continued to show a higher biochemical control rate compared with the conventional radiation group (3-year actuarial rates of 86% vs 53%).

DISCUSSION

These preliminary results show a significant improvement in the biochemical response rate with conformal boost brachytherapy and pelvic external radiation compared with conventional radiation alone. These results, coupled with our previously reported acceptable toxicity rates, support the use of this technique.

Authors+Show Affiliations

Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

9403047

Citation

Stromberg, J S., et al. "Conformal High Dose Rate Iridium-192 Boost Brachytherapy in Locally Advanced Prostate Cancer: Superior Prostate-specific Antigen Response Compared With External Beam Treatment." The Cancer Journal From Scientific American, vol. 3, no. 6, 1997, pp. 346-52.
Stromberg JS, Martinez AA, Horwitz EM, et al. Conformal high dose rate iridium-192 boost brachytherapy in locally advanced prostate cancer: superior prostate-specific antigen response compared with external beam treatment. Cancer J Sci Am. 1997;3(6):346-52.
Stromberg, J. S., Martinez, A. A., Horwitz, E. M., Gustafson, G. S., Gonzalez, J. A., Spencer, W. F., Brabbins, D. S., Dmuchowski, C. F., Hollander, J. B., & Vicini, F. A. (1997). Conformal high dose rate iridium-192 boost brachytherapy in locally advanced prostate cancer: superior prostate-specific antigen response compared with external beam treatment. The Cancer Journal From Scientific American, 3(6), 346-52.
Stromberg JS, et al. Conformal High Dose Rate Iridium-192 Boost Brachytherapy in Locally Advanced Prostate Cancer: Superior Prostate-specific Antigen Response Compared With External Beam Treatment. Cancer J Sci Am. 1997 Nov-Dec;3(6):346-52. PubMed PMID: 9403047.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conformal high dose rate iridium-192 boost brachytherapy in locally advanced prostate cancer: superior prostate-specific antigen response compared with external beam treatment. AU - Stromberg,J S, AU - Martinez,A A, AU - Horwitz,E M, AU - Gustafson,G S, AU - Gonzalez,J A, AU - Spencer,W F, AU - Brabbins,D S, AU - Dmuchowski,C F, AU - Hollander,J B, AU - Vicini,F A, PY - 1997/12/24/pubmed PY - 1997/12/24/medline PY - 1997/12/24/entrez SP - 346 EP - 52 JF - The cancer journal from Scientific American JO - Cancer J Sci Am VL - 3 IS - 6 N2 - PURPOSE: Prostate-specific antigen levels are used to judge disease control of prostate cancer. No published data attest to the greater ability of conformal brachytherapy to control disease compared with conventional radiation at a single institution. This report compares the biochemical response rates in patients with stages T2b to T3c prostate cancer treated with conformal brachytherapy boost and external beam radiation with the rates in patients treated with conventional external radiation alone. MATERIALS AND METHODS: From November 1991 through November 1995, 58 patients received 45.6 Gy pelvic external irradiation and three high dose rate iridium-192 conformal boost implants of 5.5 to 6.5 Gy each. They were compared with 278 similarly staged patients treated from January 1987 through December 1991 with external beam radiation to prostate-only fields (median dose 66.6 Gy). No patient received androgen deprivation. Patient outcome was analyzed for biochemical control. Biochemical failure was defined as a prostate-specific antigen level > 1.5 ng/mL and rising on two consecutive values. If serial posttreatment prostate-specific antigen levels were showing a continuous downward trend, failure was not scored. RESULTS: Median follow-up was 43 months for the conventionally treated group and 26 months for the brachytherapy boost group. The median pretreatment prostate-specific antigen level was 14.3 ng/mL for the external-beam-radiation-alone group and 14.0 ng/mL for the brachytherapy boost group. The median Gleason scores were 6 and 7, respectively, for the two groups. The biochemical control rate was significantly higher in the brachytherapy boost treatment group. Three-year actuarial biochemical control rates were 85% versus 52% for the conformally and conventionally treated patients, respectively. In a multivariate analysis, the use of conformal brachytherapy boost and pretreatment prostate-specific antigen level were significant prognostic determinants of biochemical control. The 3-year actuarial rates of biochemical control for conformally versus conventionally treated patients, respectively, were 83% versus 72% for a pretreatment prostate-specific antigen level of 4.1 to 10.0 ng/mL, 85% versus 47% for a prostate-specific antigen level of 10.1 to 20.0 ng/mL, and 89% versus 29% for prostate-specific antigen > 20 ng/mL. When the analysis was limited to patients in both groups with a minimum 12-month follow-up, the brachytherapy boost group continued to show a higher biochemical control rate compared with the conventional radiation group (3-year actuarial rates of 86% vs 53%). DISCUSSION: These preliminary results show a significant improvement in the biochemical response rate with conformal boost brachytherapy and pelvic external radiation compared with conventional radiation alone. These results, coupled with our previously reported acceptable toxicity rates, support the use of this technique. SN - 1081-4442 UR - https://www.unboundmedicine.com/medline/citation/9403047/Conformal_high_dose_rate_iridium_192_boost_brachytherapy_in_locally_advanced_prostate_cancer:_superior_prostate_specific_antigen_response_compared_with_external_beam_treatment_ L2 - http://www.diseaseinfosearch.org/result/9175 DB - PRIME DP - Unbound Medicine ER -