Does the sequence of high-dose rate brachytherapy boost and IMRT for prostate cancer impact early toxicity outcomes? Results from a single institution analysis.

Autor:	Roy A; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Brenneman RJ; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Hogan J; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Barnes JM; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Huang Y; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Morris R; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Goddu S; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Altman M; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Garcia-Ramirez J; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Li H; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Zoberi JE; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Bullock A; Department of Urology, Washington University School of Medicine, St. Louis, MO, United States., Kim E; Department of Urology, Washington University School of Medicine, St. Louis, MO, United States., Smith Z; Department of Urology, Washington University School of Medicine, St. Louis, MO, United States., Figenshau R; Department of Urology, Washington University School of Medicine, St. Louis, MO, United States., Andriole GL; Department of Urology, Washington University School of Medicine, St. Louis, MO, United States., Baumann BC; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Michalski JM; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States., Gay HA; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States.
Jazyk:	angličtina
Zdroj:	Clinical and translational radiation oncology [Clin Transl Radiat Oncol] 2021 May 13; Vol. 29, pp. 47-53. Date of Electronic Publication: 2021 May 13 (Print Publication: 2021).
DOI:	10.1016/j.ctro.2021.05.004
Abstrakt:	Background: We present the first report comparing early toxicity outcomes with high-dose rate brachytherapy (HDR-BT) boost upfront versus intensity modulated RT (IMRT) upfront combined with androgen deprivation therapy (ADT) as definitive management for intermediate risk or higher prostate cancer. Methods and Materials: We reviewed all non-metastatic prostate cancer patients who received HDR-BT boost from 2014 to 2019. HDR-BT boost was offered to patients with intermediate-risk disease or higher. ADT use and IMRT target volume was based on NCCN risk group. IMRT dose was typically 45 Gy in 25 fractions to the prostate and seminal vesicles ± pelvic lymph nodes. HDR-BT dose was 15 Gy in 1 fraction, delivered approximately 3 weeks before or after IMRT. The sequence was based on physician preference. Biochemical recurrence was defined per ASTRO definition. Gastrointestinal (GI) and Genitourinary (GU) toxicity was graded per CTCAE v5.0. Pearson Chi-squared test and Wilcoxon tests were used to compare toxicity rates. P -value < 0.05 was significant. Results: Fifty-eight received HDR-BT upfront (majority 2014-2016) and 57 IMRT upfront (majority 2017-2018). Median follow-up was 26.0 months. The two cohorts were well-balanced for baseline patient/disease characteristics and treatment factors. There were differences in treatment sequence based on the year in which patients received treatment. Overall, rates of grade 3 or higher GI or GU toxicity were <1%. There was no significant difference in acute or late GI or GU toxicity between the two groups. Conclusion: We found no significant difference in GI/GU toxicity in intermediate-risk or higher prostate cancer patients receiving HDR-BT boost upfront versus IMRT upfront combined with ADT. These findings suggest that either approach may be reasonable. Longer follow-up is needed to evaluate late toxicity and long-term disease control. Competing Interests: Dr. Baumann reports other from Mevion Medical Systems, personal fees and other from Regeneron Pharmaceuticals Inc., personal fees and other from Sanofi S.A., outside the submitted work. The remaining authors have no conflicts to report. (© 2021 Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.)
Databáze:	MEDLINE
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