Radiother Oncol 2012 Feb 16
Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer.
Abstract
Background
A randomised phase-III trial compared external beam radiotherapy (EBRT) alone with EBRT combined with high-dose-rate brachytherapy boost (HDR-BTb) in localised prostate adenocarcinoma.
Methods
From December 1997 to August 2005, 218 patients were assigned to EBRT alone (n=108) or EBRT followed by a temporary high-dose-rate implant (n=110). Patients were stratified according to tumour stage, PSA, Gleason score and androgen deprivation therapy (ADT). Biochemical/clinical relapse-free survival (RFS) was the primary endpoint. Secondary endpoints were overall survival (OS), urinary and bowel toxicity.
Results
RFS was significantly higher in patients treated with EBRT+HDR-BTb (log rank p=0.04). In multivariate analysis treatment arm, risk category and ADT were significant covariates for risk of relapse. Differences in OS were not significant. Incidence of severe late urinary and bowel morbidity was similar.
Conclusions
EBRT+HDR-BTb resulted in a significant improvement in RFS compared to EBRT alone with a 31% reduction in the risk of recurrence (p=0.01) and similar incidence of severe late urinary and rectal morbidity.
Related Questions
How would you optimally boost patients with high or very high risk prostate cancer receiving definitive radiotherapy in 2025?
Micro-boost is my preferred strategy for dose escalation. The FLAME trial demonstrated a bDFS benefit (Kerkmeijer et al., PMID 33471548). The secondary analysis demonstrated reduced regional+distant metastasis and reduced local recurrence, as well (Groen et al., PMID 34953603). These benefits were ...
What duration of ADT + abiraterone do you recommend prior to initiation of HDR brachytherapy followed by EBRT for very high risk localized cT3bN0 prostate cancer?
This is a short answer (for me) given the lack of data to support brachy boost in T3b disease in a randomized trial.The only randomized multicenter trial comparing dose-escalated EBRT to brachy boost is ASCENDE-RT. They specifically excluded T3b patients (see supplementary content for all exclusion ...