Important Studies Flashcards
Brachytherapy boost: EBRT + LDR boost vs. EBRT alone
ASCENDE-RT: “Morris et al, IJROBP, 2017. “intermediate and high risk prostate cancer (66% high risk and 33% int risk). Excluded: T3b, T4, PSA>40, prior TURP. “12 mos ADT + 46 Gy WPRT then: →LDR boost (115 Gy I-125)
vs. EBRT boost (78 Gy total)”. BPFS improved. No difference in OS, CSS, or DM. 9-yr PFS 83% LDR boost vs. 62% EBRT boost. “LDR boost with EBRT doubled BC compared to EBRT alone. LDR led to a marked increase in GU toxicity and trended towards worse GI toxicity.”
Brachytherapy boost: EBRT + HDR boost vs. EBRT alone
McMaster University, Ontario, Canada: “Sathya et al, JCO, 2005. “prostate cancet T2-3, surgically staged node negative (60% high risk)” EBRT with HDR boost (40 Gy/20 fx then 35 Gy/48 hr) vs. EBRT only (66 Gy/33 fx). BPFS improved. No difference in OS, CSS, or DM
Mount Vernon Hospital, Northwood, UK: Hoskin et al, Radiother Oncol, 2012. “Localized prostate cancer (~53% high risk, 42% int risk, 5% low risk). Excluded: T4, PSA >50”“→EBRT to prostate with HDR boost (37.5 Gy/13 fx then HDR 2 x 8.5 Gy) vs. EBRT to prostate only (55 Gy/20 fx) “BPFS improved. No difference in OS or DM. HDR boost with EBRT improved PFS compared to EBRT alone. HDR led to a marked increase in GU toxicity.
Brachytherapy boost: EBRT + LDR boost vs. LDR alone
RTOG 0232: “Prestidge et al, ASTRO, 2016. intermediate risk prostate cancer: T1c-T2b and GS 2-6/PSA 10-20 or GS7/PSA<10. “→45 Gy partial pelvis EBRT/IMRT+LDR
vs. LDR alone”. 5-yr PFS no change 85% vs. 86%
Acute grade ≥3 toxicity was 8% in both. “LDR boost with EBRT improved PFS compared to LDR alone. LDR boost with EBRT had worse toxicity.”
Brachytherapy: HDR
Mount Vernon, Middlesex, UK: Corner et al, IJROBP 2008. locally advanced prostate cancer. Phase II: HDR 34 Gy/4 fx, 36 Gy/4 fx, 31.5 Gy/3 fx. At short term f/u, BC with HDR is favorable and seems safe.
William Beaumont: Siddiqui et al, IJROBP, 2019. low and int risk. ≤T2a, PSA≤15, GS≤7, volume ≤50 cc, AUA ≤12. Prospective: HDR 19 Gy single fx with Ir-192. Failures were higher than expected. Additional trials should be performed to establish the optimal dose. Toxicity is low.
Brachytherapy: LDR
RTOG 9805: Lawton et al, IJROBP, 2007. low risk, T1b-T2a, PSA ≤10, Gleason ≤6. LDR with I-125 to 145 Gy. “5-yr BF 6%, 5-yr OS 97%. acute grade 3 toxicity in n=8, and late GU grade 3 in 2 “. LDR results in excellent BC and low toxicity.
MDACC: Frank et al, IJROBP, 2018. Intermediate risk prostate cancer, ≤T2b, T3 excluded with MRI, GS 6 and PSA 10-15, or GS 7 PSA <10. Prospective Phase II at MDACC. LDR with I-125 to 145 Gy, Pd-103 to 125 Gy, or Cs-131 to 115 Gy. LDR results in excellent BC and low toxicity.
Mount Sinai: Kollmeier et al, IJROBP, 2003. localized prostate cancer patients who received I-125 LDR implants. For low risk patients who received optimal implant (D90>=140 Gy), 8-yr BFFF 94% vs. 75%. LDR results in excellent BC. Results are dependent upon the quality of the implant.
Brachytherapy: Salvage LDR
RTOG 0526: Crook et al, IJROBP, 2019. Low or int risk, biopsy proven recurrence, PSA<10, failure >30 mos after EBRT. “LDR I-125 to 140 Gy or Pd-103 to 120 Gy
Goal grade 3 < 20%”. “14% late grade 3 adverse events
Higher V100 predicted late events”. Grade 3 toxicity with salvage LDR did not exceed the predetermined threshhold.
