High-dose-rate brachytherapy for large prostate volumes (≥50 cc)—Uncompromised dosimetric coverage and acceptable toxicity
Section snippets
Purpose
Low-dose-rate (LDR) brachytherapy with permanent radioactive seeds has become a standard treatment for localized prostate cancer over the past decade. Historically, patients with large-volume glands (>50–60 cc) have been considered suboptimal candidates for LDR brachytherapy. It has been shown that prostate volume correlates directly with the ability to perform an adequate permanent seed implant [1], [2], [3], post-treatment urinary symptoms [4], [5], [6], [7], [8], and pubic arch interference
Patient selection
The records of 315 patients treated with HDR brachytherapy for clinically localized prostate cancer at the Penrose Cancer Center between 2001 and 2006 were retrospectively reviewed under institutional review board approval. From the entire cohort of eligible patients, 54 were identified as having a preimplant ultrasound volume of at least 50 cc (range, 50–97.3 cc; mean, 61.5 cc; median, 57 cc; upper quartile, 83.3–97.3 cc). Neoadjuvant hormones (17 of 54 patients) were not routinely recommended
Results
Table 1 summarizes pretreatment clinical characteristics of the 54 eligible patients.
All dosimetric goals were adequately achieved. The median D90 (minimal dose to 90% of the prostate) was 109% of prescription dose (range, 95–115%). The median V100 (volume receiving 100% of the prescribed dose) was 96% (range, 90–99). V150 ranged from 10% to 35%, with a median value of 18.3%. The median dose to the maximally irradiated 5% of rectum and bladder was 56% and 49% of the implant dose, respectively.
Discussion
Performing permanent LDR prostate brachytherapy on large-volume glands is fraught with difficulties, ranging from inadequate coverage to excessive toxicity. Conventional wisdom previously held that glands >50–60 cc may be better treated with surgery or external beam radiation, though this notion may be challenged with modern LDR techniques. This study supports the notion that HDR brachytherapy may be a reasonable option for patients with large glands.
The primary goal of this study was to show
Conclusions
Large prostate volume is not a contraindication to HDR brachytherapy. Excellent dosimetric coverage can be attained with acceptable acute toxicity.
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Does prostate volume has an impact on biochemical failure in patients with localized prostate cancer treated with HDR boost?
2016, Radiotherapy and OncologyCitation Excerpt :In this paper, we have presented the results of the largest known study on the impact of prostate volume on clinical outcome and toxicity in prostate cancer patients treated with HDR boost. Our results concur with the smaller studies of Monroe et al. (N=54) and Le et al. (N = 164) and show that HDR boost treatment in patients with lager prostate volume (⩾60 cc) does not increase risk of biochemical failure and acute and late GU and GI toxicities [10,15]. Similarly to the Le et al. study, we compared PSA failure and GU and GI toxicities of the larger glands group with a cohort of patient with smaller glands treated during the same period.
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