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Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution

BACKGROUND: Focal treatment for prostate cancer (PCa) is a hybrid approach combining ablative treatment of the involved prostate gland and continued active surveillance (AS) of the unaffected gland. Low dose-rate (LDR) brachytherapy can be used as a lesion-targeted focal therapy, however, further st...

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Autores principales: Anderson, Elliot, Smyth, Lloyd M. L., O’Sullivan, Richard, Ryan, Andrew, Lawrentschuk, Nathan, Grummet, Jeremy, See, Andrew W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511546/
https://www.ncbi.nlm.nih.gov/pubmed/34733655
http://dx.doi.org/10.21037/tau-21-508
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author Anderson, Elliot
Smyth, Lloyd M. L.
O’Sullivan, Richard
Ryan, Andrew
Lawrentschuk, Nathan
Grummet, Jeremy
See, Andrew W.
author_facet Anderson, Elliot
Smyth, Lloyd M. L.
O’Sullivan, Richard
Ryan, Andrew
Lawrentschuk, Nathan
Grummet, Jeremy
See, Andrew W.
author_sort Anderson, Elliot
collection PubMed
description BACKGROUND: Focal treatment for prostate cancer (PCa) is a hybrid approach combining ablative treatment of the involved prostate gland and continued active surveillance (AS) of the unaffected gland. Low dose-rate (LDR) brachytherapy can be used as a lesion-targeted focal therapy, however, further studies are required to support its use. The aim of this study is to evaluate the dosimetry, toxicity and oncological outcomes of men receiving lesion-targeted focal LDR brachytherapy for low to intermediate risk PCa. METHODS: This is a retrospective cohort study of 26 men with unifocal, low to intermediate grade PCa diagnosed on a combination of multiparametric-magnetic resonance imaging (mp-MRI) and targeted plus template transperineal (TP) biopsy, who received focal LDR brachytherapy at a single institution. Brachytherapy involved a single monotherapy implant using iodine-125 seeds to deliver a prescribed dose of 145 Gy to the index lesion. RESULTS: The mean focal planning target volume (F-PTV) as a percentage of the prostate volume was 24.5%. The percentage of the focal gross tumour volume (F-GTV) receiving 100% of the prescription dose was 100% for 12 patients and ≥98% for 18 patients. The median follow-up for toxicity and biochemical control outcomes was 23.1 [interquartile range (IQR) 19.1–31.3] and 24.2 (IQR 17.9–30.0) months, respectively. Grade 2 urinary and erectile toxicities were reported by 29.2% and 45.8% of patients, respectively, with resolution of urinary symptoms to baseline by last follow-up. There were no grade ≥3 urinary or erectile toxicities or grade ≥2 rectal toxicity. All 21 patients who underwent a repeat mp-MRI and TP biopsy at 12–24 months post-treatment were negative for clinically significant disease and 25 (96.2%) patients were free from biochemical failure (FFBF). CONCLUSIONS: Focal LDR brachytherapy is associated with a favourable toxicity profile and a high rate of control of significant PCa at 12–18 months post-treatment. We have commenced the LIBERATE prospective registry in focal LDR brachytherapy based on the highly encouraging outcomes of this initial experience.
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spelling pubmed-85115462021-11-02 Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution Anderson, Elliot Smyth, Lloyd M. L. O’Sullivan, Richard Ryan, Andrew Lawrentschuk, Nathan Grummet, Jeremy See, Andrew W. Transl Androl Urol Original Article BACKGROUND: Focal treatment for prostate cancer (PCa) is a hybrid approach combining ablative treatment of the involved prostate gland and continued active surveillance (AS) of the unaffected gland. Low dose-rate (LDR) brachytherapy can be used as a lesion-targeted focal therapy, however, further studies are required to support its use. The aim of this study is to evaluate the dosimetry, toxicity and oncological outcomes of men receiving lesion-targeted focal LDR brachytherapy for low to intermediate risk PCa. METHODS: This is a retrospective cohort study of 26 men with unifocal, low to intermediate grade PCa diagnosed on a combination of multiparametric-magnetic resonance imaging (mp-MRI) and targeted plus template transperineal (TP) biopsy, who received focal LDR brachytherapy at a single institution. Brachytherapy involved a single monotherapy implant using iodine-125 seeds to deliver a prescribed dose of 145 Gy to the index lesion. RESULTS: The mean focal planning target volume (F-PTV) as a percentage of the prostate volume was 24.5%. The percentage of the focal gross tumour volume (F-GTV) receiving 100% of the prescription dose was 100% for 12 patients and ≥98% for 18 patients. The median follow-up for toxicity and biochemical control outcomes was 23.1 [interquartile range (IQR) 19.1–31.3] and 24.2 (IQR 17.9–30.0) months, respectively. Grade 2 urinary and erectile toxicities were reported by 29.2% and 45.8% of patients, respectively, with resolution of urinary symptoms to baseline by last follow-up. There were no grade ≥3 urinary or erectile toxicities or grade ≥2 rectal toxicity. All 21 patients who underwent a repeat mp-MRI and TP biopsy at 12–24 months post-treatment were negative for clinically significant disease and 25 (96.2%) patients were free from biochemical failure (FFBF). CONCLUSIONS: Focal LDR brachytherapy is associated with a favourable toxicity profile and a high rate of control of significant PCa at 12–18 months post-treatment. We have commenced the LIBERATE prospective registry in focal LDR brachytherapy based on the highly encouraging outcomes of this initial experience. AME Publishing Company 2021-09 /pmc/articles/PMC8511546/ /pubmed/34733655 http://dx.doi.org/10.21037/tau-21-508 Text en 2021 Translational Andrology and Urology. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Anderson, Elliot
Smyth, Lloyd M. L.
O’Sullivan, Richard
Ryan, Andrew
Lawrentschuk, Nathan
Grummet, Jeremy
See, Andrew W.
Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution
title Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution
title_full Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution
title_fullStr Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution
title_full_unstemmed Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution
title_short Focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an Australian institution
title_sort focal low dose-rate brachytherapy for low to intermediate risk prostate cancer: preliminary experience at an australian institution
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511546/
https://www.ncbi.nlm.nih.gov/pubmed/34733655
http://dx.doi.org/10.21037/tau-21-508
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