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ASTRO 2023: Is Less More in High-Dose–Rate Brachytherapy for Localized Prostate Cancer?

By: Joseph Cupolo
Posted: Monday, October 16, 2023

Concerns surrounding the efficacy of single-dose (19–20 Gy) high-dose–rate brachytherapy (HDR-BT) monotherapy for localized prostate cancer, based on data from a 2017 phase II trial, may have been unfounded, according to Peter Hoskin, MD, of Mount Vernon Hospital, Northwood, Hillingdon, United Kingdom, and colleagues. Long-term outcome data up to 10 years showed no significant difference in prostate-specific antigen (PSA) control and overall survival with this single dose strategy compared with two and three fractions of HDR-BT. These results were presented at the 2023 American Society for Radiology Oncology (ASTRO) Annual Meeting (Abstract 1000).

The trial was initiated to evaluate long-term freedom from biochemical relapse and overall survival after single-dose HDR-BT compared with two or three fraction schedules. HDR-BT regimens were delivered as 1 x 19 Gy or 1 x 20 Gy (group A = 49), 2 x 13 Gy (group B = 138), or 3 x 10.5 Gy (group C = 106) to patients with intermediate- or high-risk prostate cancer as their sole treatment. Median follow-up was 123, 116, and 120 months (P = .4), respectively. Neo-adjuvant and adjuvant androgen-deprivation treatment was given to 80% of all patients. The median duration of treatment was 9 months (group A) and 6 months (groups B and C). Kaplan-Meier estimates of freedom from biochemical relapse, at 8 and 10 years, were 67% and 64% (group A), 78% and 72% (group B), and 80% and 76% (group C). Differences in these rates among dose groups were not significant (P = .2).

“For risk of death, Gleason risk (low, intermediate, high), MRI tumor stage risk, and overall risk category were significant in univariate analyses,” they reported, whereas tumor stage and Gleason risk were significant in multivariate analyses.

Disclosure: Dr. Hoskin reported no conflicts of interest.

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