ASCO GU 2008 - Brachytherapy: More Is Better

Main Category: Urology / Nephrology
Also Included In: Radiology / Nuclear Medicine
Article Date: 16 Feb 2008 - 1:00 PDT

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UroToday.com - A survey in 2002 reported that half of urologists in the US offer brachytherapy. The concept of radiation guidance can be either giving radiotherapy via beam or needles. He argued that prostate IG-HDR delivers high doses to the prostate and not the rectum or urethra. He presented a 5-week hyperfractionated protocol of EBRT and HDR boost. The 5-year outcomes of 267 patients treated with high doses revealed the biochemical control is 90%, compared to 68.7% for low dose. Overall survival at 5 years was better with the high dose combination. The mean dose delivered is 77Gy in the ART group which is higher than the 68Gy in the ERBT group. The HDR prostate bed dose was biologically much higher. Patients receiving HDR boost do better regarding 10 survival results with 76% having biochemical freedom from disease. The distant metastatic rate of HDR is also less than ERBT + ART.

In a study evaluating HDR alone compared to HDR + ADT it was found that there was no benefit to the combined therapy. In those with poor prognostic factors, the patients receiving ADT and HDR had worse survival, which was surprising. This has prompted a 3 arm study of XRT alone, XRT + ADT for duration of 24 months and XRT + ADT + boost. Thus HDR using >210Gy dose delivered to the prostate bed results in a survival benefit at 5 and 10 years.

Presented by Alvaro Martinez at the American Society of Clinical Oncology (ASCO) - 2008 Genitourinary Cancers Symposium - A Multidisciplinary Approach - February 14-16, 2008 San Francisco, California, USA

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

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