Toxicity and risk factors after combined high-dose-rate brachytherapy and external beam radiation therapy in men ≥75 years with localized prostate cancer.
Strahlenther Onkol
; 195(5): 374-382, 2019 May.
Article
in En
| MEDLINE
| ID: mdl-30390115
ABSTRACT
PURPOSE:
Combined high-dose-rate brachytherapy (HDR-BT) and external beam radiation therapy (EBRT) is a favorable treatment option in non-metastatic prostate cancer. However, reports on toxicity and outcome have mainly focused on younger patients. We aimed to determine toxicity and biochemical control rates after combined HDR-BT and EBRT in men ≥75 years.METHODS:
From 1999 to 2015, 134 patients aged ≥75 years (median 76 years; 75-82 years) were identified. Patients received 18â¯Gy of HDR-BT (9â¯Gy/fraction on days 1 and 8) with an iridium-192 source. After 1 week, supplemental EBRT with a target dose of 50.4â¯Gy was started (delivered in 1.8â¯Gy fractions).RESULTS:
Median follow-up time was 25 months (0-127 months). No severe (grade 4) gastrointestinal (GIT) or genitourinary (GUT) toxicities were observed. In 76 patients (56.7%), 3D conformal radiation therapy (CRT) and in 34.3% intensity-modulated radiotherapy (IMRT) was applied. CRT-treated patients were at a 2.17-times higher risk (hazard ratio [HR] 2.17, 95% confidence interval [CI] 1.31-3.57, pâ¯= 0.002) of experiencing GUT. GIT risks could be reduced by 78% using IMRT (HR 0.22, 95% CI 0.07-0.75, pâ¯= 0.015). Patients with a higher T stage (T2c-3a/b) were less likely to experience GIT or GUT (HR 0.49, 95% CI 0.29-0.85, pâ¯= 0.011 and HR 0.5, 95% CI 0.3-0.81, pâ¯= 0.005, respectively).CONCLUSION:
HDR-BT/EBRT is a well-tolerated treatment option for elderly men ≥75 years with a limited number of comorbidities and localized intermediate- or high-risk prostate cancer. IMRT should be favored since side effects were significantly reduced in IMRT-treated patients.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Prostatic Neoplasms
/
Radiation Injuries
/
Brachytherapy
/
Radiotherapy, Conformal
/
Radiotherapy, Intensity-Modulated
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Humans
/
Male
Language:
En
Journal:
Strahlenther Onkol
Journal subject:
NEOPLASIAS
/
RADIOTERAPIA
Year:
2019
Type:
Article
Affiliation country:
Germany