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KMID : 1038620220400030200
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Radiation Oncology Journal
2022 Volume.40 No. 3 p.200 ~ p.207
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A comparison between high dose rate brachytherapy and stereotactic body radiotherapy boost after elective pelvic irradiation for high and very high-risk prostate cancer
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Novikov Sergey Nikolaevich
Novikov Roman Vladimirovich
Merezhko Yurii Olegovich
Gotovchikova Mariya Yurevna
Ilin Nikolai Dmitrievich
Melnik Yulia Sergeevna
Kanaev Sergey Vasilevich
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Abstract
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Purpose: To compare biochemical recurrence-free survival (BRFS) and toxicity outcomes of high dose rate brachytherapy (HDRB) and stereotactic body radiotherapy (SBRT) boost after elective nodal irradiation for high/very high-risk prostate cancer.
Materials and Methods: A retrospective analysis was performed in 149 male patients. In 98 patients, the boost to the prostate was delivered by HDRB as 2 fractions of 10 Gy (EQD2 for α/β = 1.5; 66 Gy) or 1 fraction of 15 Gy (EQD2 for α/β = 1.5; 71 Gy). In 51 male patients, SBRT was used for the boost delivery (3 fractions of 7 Gy; EQD2 for α/β = 1.5; 51 Gy) because brachytherapy equipment was out of order.
Results: In 98 patients that received HDRB boost, 3- and 5-year BRFS were 74.6% and 66.8%. Late grade-II genitourinary toxicity was detected in 27, grade-III in 1 case. Grade-II (maximum) rectal toxicity was diagnosed in nine patients. For 51 male patients that received SBRT boost, 3- and 5-year BRFS was 76.5% and 67.7%. Late grade-II (maximum) genitourinary toxicity was detected in five cases, late grade-II rectal toxicity in four cases. Other three patients developed late grade-III?IV rectal toxicity that required diverting colostomy. SBRT boost was associated with higher maximum dose to 2 cm3 of anterior rectal wall (D2cm³rectum) compared to HDRB: 92% versus 55% of dose to prostate. Severe rectal toxicity was negligible at EQD2 D2cm³rectum <85 Gy and EQD2 D5cm³ rectum <75 Gy.
Conclusion: Our results indicate similar 3- and 5-year BRFS in patients with high/very high-risk prostate cancer who received HDRB or SBRT boost, but SBRT boost is associated with higher rate of severe late rectal toxicity.
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KEYWORD
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Prostate cancer, Stereotactic body radiotherapy, Brachytherapy, Multimodal treatment, Boost
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