World Congress of Brachytherapy, Boston, May, 4-6, 2008

Prospective study on quality-of-life and toxicity of high-dose-rate brachytherapy as an interstitial boost for localized prostate cancer

Spira G, Weise C, Neubauer S, Blumberg J, Ernst C, Mühlnickel W, Derakhshani P   (1) West German Prostate Center, Cologne, Germany

(2) Department of Urology, Klinik am Ring, Cologne

(3) Department of Radiooncology, Klinik am Ring, Cologne 

Background and purpose:

We report on the outcome, toxicities and quality-of-life (QoL) of patients after high-dose-rate (HDR)-brachytherapy as a boost to external beam radiotherapy (EBR) for intermediate and high risk localized prostate cancer.

Materials and methods:

416 patients were treated in a single institution with HDR-brachytherapy in afterloading-technique as a boost to 3D-conformal EBR (50.4 Gy) between April 2003 and December 2006. Patients were classified as low-risk in 7.8%, intermediate-risk in 40.1% and high-risk in 52.1%. 53% of patients received neoadjuvant or adjuvant androgen deprivation therapy. Patients were followed in terms of PSA-levels, QoL, urinary function and sexual status. Validated questionnaires (IPSS; EORTC QLQ C30, PR25-Prostate-Module, IIEF5) were prospectively administered to all patients before and at 1, 3, 6, 12 and 24 months after treatment.


Median follow-up of patients was 34 months (12-56 months). Median PSA for intermediate-risk and high-risk groups decreased from initially 11 ng/ml to 0.15 ng/ml after 36 months. 3-year biochemical control rate for hormone naive patients, as defined by the ASTRO, was 87%. Urinary function (before HDR mean IPSS 8.9) worsened at 3, 6 and 12 months after HDR but remained stable (mean IPSS 10.6/9.3/10.3). Urinary bother score (UB) in PR25 was 30.17 immediately after HDR and improved significantly over the next twelve months (mean UB 23.61) to almost baseline 19.05 at 24 months. There was no change in bowel function (BF) throughout the study period (before HDR score 4.06, after HDR mean score 5.81). General health status (GHS) before HDR was excellent (score 72.41) and showed only slight decrease at all intervals after HDR (mean score 67.25). At 24 months patients reached baseline in GHS with a mean score of 69.84.


Combined HDR-brachytherapy for intermediate and high-risk prostate cancer results in excellent biochemical control and quality of life with minor acute or late complications.


HDR boost (real time) in patients with localized prostate cancer: technical description and preliminary results

Spira G1, Weise C1, Neubauer S2, Blumberg J1, Ernst C1, Mühlnickel W1, Derakhshani P2

Department of Radiation Oncology, Klinik am Ring, Cologne 1

Department of Urology, Klinik am Ring, Cologne 2


It has been well documented that the outcome of prostate cancer treatment depends on the dose administered. Hence, techniques have been developed that allow high-dose administration without increasing the complications, e.g. external radiotherapy combined with high-dose radiation (HDR) boost. In this study we analyse the technique and protocol of real-time HDR boost together with clinical results and quality of dosimetric parameters that support its use.

Patients and Methods:

Between June 2003 and December 2007, 416 patients with prostate cancer were treated with 50.4 Gy of external irradiation to the pelvis (single fraction 1.8 Gy) and 3 HDR brachytherapy fractions (each 7.5Gy) at the end of a 5-week radiotherapy course. All brachytherapy implants were planned using the Nucletron SWIFT realtime ultrasound based planning system. The 1997 American Joint Commission on Cancer (AJCC) system was used to establish disease stage. Patients with low-risk (7.8%), intermediate-risk (40.1%) and high-risk (52.1%) without metastases were eligible for the brachytherapy. 53% of Patients received neoadjuvant or adjuvant androgen deprivation therapy. Biochemical failure was defined according to the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus panel statement. Toxicity was scored according to RTOG guidelines.


The mean age of patients was 67.5 years (range 50.5-86). Median follow-up was 31 months (range: 12-56). Median PSA decreased from initially 11 ng/ml to 0.15 ng/ml after 36 months. No grade 4 complications were noted. Mean V100 prostate in all patients was 94.8% (range 74-99.8), mean D90 prostate was 7.97 Gy (range 5.3-9.8), median D10 urethra was 8.56 Gy (range 6.9-11.2) and median D10 rectum was 4.5 Gy (range 2.0-7.4). Patients were stratified for prostate volume. In the 76 patients with prostate volumes above 40 cc there was no major difference in dosimetric quality as compared to small prostates (D90 Prostate 7.96 vs. 7.97, V100 93.6 vs. 95.1, D10 Urethra 8.58 vs. 8.55, D10 Rectum 4.96 vs. 4.36).


The good results of biochemical control, few complications and excellent quality of dosimetric parameters suggest that external radiotherapy combined with HDR brachytherapy should be considered as first-choice in the treatment of localised prostate cancer of high- and intermediate-risk. Our study could prove that large prostates can be treated with equal dosimetric results as small glands.

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