High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes

Michael Chao, Damien Bolton, Daryl Lim Joon, Yee Chan, Nathan Lawrentschuk, Huong Ho, Sandra Spencer, Jason Wasiak, Mario Guerrieri, Darren Ow, Andrew Troy, Trung Pham, Shomik Sengupta, Alwin Tan, Kevin McMillan, George Koufogiannis, Farshad Foroudi, Michael Ng, Vincent Khoo

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

Introduction: To examine the long-term outcomes of high dose rate brachytherapy boost (HDR-BT) combined with external beam radiotherapy (EBRT) for intermediate and high-risk prostate cancer patients. Methods: Data from 95 patients who underwent combined EBRT (50.4 Gy) and HDR-BT to the prostate between 2010 and 2017 were retrospectively analysed. Biochemical progression free survival (bPFS), local recurrence free survival (LRFS), metastatic free survival (MFS) and overall survival (OS) were estimated using Kaplan–Meier method. Regression analysis was conducted to identify important predictors of outcomes. Results: A total of 24 patients received an initial HDR-BT dose of 18 Gy in three fractions, with the remaining 71 patients receiving 16 Gy in two fractions as per departmental protocol changes. Most patients (88%) received androgen deprivation therapy. A transurethral resection of the prostate (TURP) was performed in 14 patients and hydrogel spacers (HS) were used in 30 patients. Median follow-up was 58 months. The 5-year bPFS, LRFS, MFS and OS were 92%, 100%, 92% and 88%. Univariate regression revealed no statistical association between patient characteristics and time to relapse (all P > 0.1). Late > grade 2 genitourinary (GU) toxicity was 6.3%. The use of HS or prior TURP had no impact on late GU toxicity. Late Grade 1 gastrointestinal (GI) toxicity was 5.3%. Conclusion: The combined HDR-BT with EBRT resulted in excellent bPFS. The cumulative risk of late GU and GI toxicity was low and can be further improved with preventative strategies such as a pre-emptive TURP and/or HS insertion.

Original languageEnglish
Pages (from-to)415–421
Number of pages7
JournalJournal of Medical Imaging and Radiation Oncology
Volume63
Issue number3
DOIs
Publication statusPublished - Jun 2019

Keywords

  • HDR brachytherapy
  • hydrogel spacers
  • prostate
  • TURP

Cite this

Chao, Michael ; Bolton, Damien ; Lim Joon, Daryl ; Chan, Yee ; Lawrentschuk, Nathan ; Ho, Huong ; Spencer, Sandra ; Wasiak, Jason ; Guerrieri, Mario ; Ow, Darren ; Troy, Andrew ; Pham, Trung ; Sengupta, Shomik ; Tan, Alwin ; McMillan, Kevin ; Koufogiannis, George ; Foroudi, Farshad ; Ng, Michael ; Khoo, Vincent. / High dose rate brachytherapy boost for prostate cancer : Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes. In: Journal of Medical Imaging and Radiation Oncology. 2019 ; Vol. 63, No. 3. pp. 415–421.
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title = "High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes",
abstract = "Introduction: To examine the long-term outcomes of high dose rate brachytherapy boost (HDR-BT) combined with external beam radiotherapy (EBRT) for intermediate and high-risk prostate cancer patients. Methods: Data from 95 patients who underwent combined EBRT (50.4 Gy) and HDR-BT to the prostate between 2010 and 2017 were retrospectively analysed. Biochemical progression free survival (bPFS), local recurrence free survival (LRFS), metastatic free survival (MFS) and overall survival (OS) were estimated using Kaplan–Meier method. Regression analysis was conducted to identify important predictors of outcomes. Results: A total of 24 patients received an initial HDR-BT dose of 18 Gy in three fractions, with the remaining 71 patients receiving 16 Gy in two fractions as per departmental protocol changes. Most patients (88{\%}) received androgen deprivation therapy. A transurethral resection of the prostate (TURP) was performed in 14 patients and hydrogel spacers (HS) were used in 30 patients. Median follow-up was 58 months. The 5-year bPFS, LRFS, MFS and OS were 92{\%}, 100{\%}, 92{\%} and 88{\%}. Univariate regression revealed no statistical association between patient characteristics and time to relapse (all P > 0.1). Late > grade 2 genitourinary (GU) toxicity was 6.3{\%}. The use of HS or prior TURP had no impact on late GU toxicity. Late Grade 1 gastrointestinal (GI) toxicity was 5.3{\%}. Conclusion: The combined HDR-BT with EBRT resulted in excellent bPFS. The cumulative risk of late GU and GI toxicity was low and can be further improved with preventative strategies such as a pre-emptive TURP and/or HS insertion.",
keywords = "HDR brachytherapy, hydrogel spacers, prostate, TURP",
author = "Michael Chao and Damien Bolton and {Lim Joon}, Daryl and Yee Chan and Nathan Lawrentschuk and Huong Ho and Sandra Spencer and Jason Wasiak and Mario Guerrieri and Darren Ow and Andrew Troy and Trung Pham and Shomik Sengupta and Alwin Tan and Kevin McMillan and George Koufogiannis and Farshad Foroudi and Michael Ng and Vincent Khoo",
year = "2019",
month = "6",
doi = "10.1111/1754-9485.12882",
language = "English",
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Chao, M, Bolton, D, Lim Joon, D, Chan, Y, Lawrentschuk, N, Ho, H, Spencer, S, Wasiak, J, Guerrieri, M, Ow, D, Troy, A, Pham, T, Sengupta, S, Tan, A, McMillan, K, Koufogiannis, G, Foroudi, F, Ng, M & Khoo, V 2019, 'High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes', Journal of Medical Imaging and Radiation Oncology, vol. 63, no. 3, pp. 415–421. https://doi.org/10.1111/1754-9485.12882

High dose rate brachytherapy boost for prostate cancer : Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes. / Chao, Michael; Bolton, Damien; Lim Joon, Daryl; Chan, Yee; Lawrentschuk, Nathan; Ho, Huong; Spencer, Sandra; Wasiak, Jason; Guerrieri, Mario; Ow, Darren; Troy, Andrew; Pham, Trung; Sengupta, Shomik; Tan, Alwin; McMillan, Kevin; Koufogiannis, George; Foroudi, Farshad; Ng, Michael; Khoo, Vincent.

In: Journal of Medical Imaging and Radiation Oncology, Vol. 63, No. 3, 06.2019, p. 415–421.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - High dose rate brachytherapy boost for prostate cancer

T2 - Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes

AU - Chao, Michael

AU - Bolton, Damien

AU - Lim Joon, Daryl

AU - Chan, Yee

AU - Lawrentschuk, Nathan

AU - Ho, Huong

AU - Spencer, Sandra

AU - Wasiak, Jason

AU - Guerrieri, Mario

AU - Ow, Darren

AU - Troy, Andrew

AU - Pham, Trung

AU - Sengupta, Shomik

AU - Tan, Alwin

AU - McMillan, Kevin

AU - Koufogiannis, George

AU - Foroudi, Farshad

AU - Ng, Michael

AU - Khoo, Vincent

PY - 2019/6

Y1 - 2019/6

N2 - Introduction: To examine the long-term outcomes of high dose rate brachytherapy boost (HDR-BT) combined with external beam radiotherapy (EBRT) for intermediate and high-risk prostate cancer patients. Methods: Data from 95 patients who underwent combined EBRT (50.4 Gy) and HDR-BT to the prostate between 2010 and 2017 were retrospectively analysed. Biochemical progression free survival (bPFS), local recurrence free survival (LRFS), metastatic free survival (MFS) and overall survival (OS) were estimated using Kaplan–Meier method. Regression analysis was conducted to identify important predictors of outcomes. Results: A total of 24 patients received an initial HDR-BT dose of 18 Gy in three fractions, with the remaining 71 patients receiving 16 Gy in two fractions as per departmental protocol changes. Most patients (88%) received androgen deprivation therapy. A transurethral resection of the prostate (TURP) was performed in 14 patients and hydrogel spacers (HS) were used in 30 patients. Median follow-up was 58 months. The 5-year bPFS, LRFS, MFS and OS were 92%, 100%, 92% and 88%. Univariate regression revealed no statistical association between patient characteristics and time to relapse (all P > 0.1). Late > grade 2 genitourinary (GU) toxicity was 6.3%. The use of HS or prior TURP had no impact on late GU toxicity. Late Grade 1 gastrointestinal (GI) toxicity was 5.3%. Conclusion: The combined HDR-BT with EBRT resulted in excellent bPFS. The cumulative risk of late GU and GI toxicity was low and can be further improved with preventative strategies such as a pre-emptive TURP and/or HS insertion.

AB - Introduction: To examine the long-term outcomes of high dose rate brachytherapy boost (HDR-BT) combined with external beam radiotherapy (EBRT) for intermediate and high-risk prostate cancer patients. Methods: Data from 95 patients who underwent combined EBRT (50.4 Gy) and HDR-BT to the prostate between 2010 and 2017 were retrospectively analysed. Biochemical progression free survival (bPFS), local recurrence free survival (LRFS), metastatic free survival (MFS) and overall survival (OS) were estimated using Kaplan–Meier method. Regression analysis was conducted to identify important predictors of outcomes. Results: A total of 24 patients received an initial HDR-BT dose of 18 Gy in three fractions, with the remaining 71 patients receiving 16 Gy in two fractions as per departmental protocol changes. Most patients (88%) received androgen deprivation therapy. A transurethral resection of the prostate (TURP) was performed in 14 patients and hydrogel spacers (HS) were used in 30 patients. Median follow-up was 58 months. The 5-year bPFS, LRFS, MFS and OS were 92%, 100%, 92% and 88%. Univariate regression revealed no statistical association between patient characteristics and time to relapse (all P > 0.1). Late > grade 2 genitourinary (GU) toxicity was 6.3%. The use of HS or prior TURP had no impact on late GU toxicity. Late Grade 1 gastrointestinal (GI) toxicity was 5.3%. Conclusion: The combined HDR-BT with EBRT resulted in excellent bPFS. The cumulative risk of late GU and GI toxicity was low and can be further improved with preventative strategies such as a pre-emptive TURP and/or HS insertion.

KW - HDR brachytherapy

KW - hydrogel spacers

KW - prostate

KW - TURP

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U2 - 10.1111/1754-9485.12882

DO - 10.1111/1754-9485.12882

M3 - Article

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VL - 63

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EP - 421

JO - Journal of Medical Imaging and Radiation Oncology

JF - Journal of Medical Imaging and Radiation Oncology

SN - 1754-9477

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ER -