Intraoperative Neurovascular Bundle Preservation with Hyaluronic Acid during Radical Brachytherapy for Localized Prostate Cancer: Technique and MicroMosfet In Vivo Dosimetry.

PURPOSE: To evaluate the reduction in the absorbed dose delivered to the neurovascular bundle (NB) in patients with localized prostate cancer treated with only HDR brachytherapy and NB protection with hyaluronic acid (HA) on the side of the prostate to increase the distance from NB to the radioactive sources. METHODS: This is the first published report in the medical literature that studies a new approach to decrease neurovascular bundle toxicity and improve quality of life for patients with prostate cancer treated with radical brachytherapy as monotherapy. Transperineal HA injection on the side of the prostate into the lateral aspect of the prostate fat was used to consistently displace several autonomic fibers and vessels on the lateral wall of the prostate away from radiation sources. RESULTS: When a protection in the form of an HA layer is placed, the reduction effect at the maximum dose is between 46% and 54% (calculated values), which means that the method for protection is highly recommended. The values of the absorbed dose calculated in this project have been compared with the ones given by the treatment planning system. CONCLUSIONS: This newly created space decreases absorbed dose in the NB, calculated with the TPS and measured by microMOSFET due to the thickness of HA.

High-dose-rate interstitial brachytherapy as monotherapy in one fraction for the treatment of favorable stage prostate cancer: Toxicity and long-term biochemical results.

BACKGROUND: To evaluate acute and late genitourinary, the gastrointestinal toxicity and the long-term biochemical control after HDR monotherapy in one fraction (19Gy). PATIENTS AND METHODS: Between April 2008 and October 2010, 60 consecutive patients were treated with favorable clinically localized prostate cancer; the median follow-up was 72months (range 32-91). All patients received one implant and one fraction of HDR. Fraction dose was 19Gy. Toxicity was reported according to the Common Toxicity Criteria for Adverse Event, Version 4.0 (CTAE v4.02) by the National Cancer Institute. RESULTS: No intraoperative or perioperative complications occurred. Acute toxicity grade 2 or more was not observed in any patients. No chronic toxicity, such as incontinence, late urinary retention, urethral narrowing, rectal bleeding, anal ulcer and/or rectourethral fistula has been observed after treatment. The overall survival and failure in tumor-free survival (TFS) according to Kaplan-Meier estimates was 90% (±5%) and 88% (±5%) respectively at 6years. The actuarial biochemical control was 66% (±6%) at 6years. CONCLUSIONS: This protocol is feasible and very well tolerated with low genitourinary morbidity, no gastrointestinal toxicity but no the same level of LDR biochemical control at 6years.

Long-term biochemical results after high-dose-rate intensity modulated brachytherapy with external beam radiotherapy for high risk prostate cancer.

BACKGROUND: Biochemical control from series in which radical prostatectomy is performed for patients with unfavorable prostate cancer and/or low dose external beam radiation therapy are given remains suboptimal.The treatment regimen of HDR brachytherapy and external beam radiotherapy is a safe and very effective treatment for patients with high risk localized prostate cancer with excellent biochemical control and low toxicity.