Clinical results

3.5.1. Clinical results of LDR brachytherapy as monotherapy

It is generally accepted that patients with low-risk disease are excellent candidate for LDR monotherapy. There is no randomized data comparing therapeutic outcomes between LDR monotherapy, surgery, and EBRT. However, multiple reports of low-risk patients treated with LDR monotherapy have demonstrated excellent long-term biochemical control rates of 80 -95% (Table 1).

Patients with intermediate-risk disease represent a heterogeneous patient population. Some of them seem to benefit from LDR monotherapy, whereas others may require combined modality approaches with EBRT and/or ADT. D'Amico et al [65] reported that percentage of positive prostate biopsy cores is a predicting factor of biochemical outcome following EBRT, particularly for intermediate-risk patients. In their report, patients with > 50% of biopsy cores positive had PSA relapse rates comparable to those of high-risk patients, whereas patients with < 34% of biopsy cores positive had favorable biochemical outcomes similar to those of low risk patients. Long-term biochemical control rate for intermediate-risk patients treated with LDR monotherapy is also favorable, ranging from 70% to 90% (Table 1).

Mean/Median

Adjuvant

bRFS rate

Authors

N

Follow-up

Hormone

Therapy

Low-risk

Intermediate-risk

High-risk

Sylvester et al

215

11.7 years

NO

15-year

[60]

85.90%

79.90%

62.20%

Prade et al

734

55 months

YES

10-year

[61]

92.00%

84%

65%

Henry et al

1298

4.9 years

YES

10-year

[62]

86.40%

76.70%

60.60%

Zelefsky et al

2693

63 months

NO

8-year

[63]

82%

70%

48%

Zelefsky et al

367

63 months

YES

5-year

[64]

96%

89%

-

Table 1. LDR brachytherapy as monotherapy

Table 1. LDR brachytherapy as monotherapy

For patients with high-risk disease, the use of supplemental beam radiation to cover the periprostatic prostate tissue has been widely practiced. However, LDR monotherapy has been good results comparable to combination of monotherapy and EBRT even in patients with high-risk disease.

3.5.2. Clinical results of combination of LDR brachytherapy and EBRT

Outcomes (bRFS rates) for a combination of LDR brachytherapy and EBRT are shown in Table 2.

Authors

N

Mean/Median

Adjuvant Hormone Therapy

bRFS rate

Follow-up

Low-risk

Intermediate-risk

High-risk

10-year

Critz et al [66]

1469

6 years

NO

93%

80%

61%

Merrick et al

204

7 years

YES

10-year

[67]

86.60%

Sylvester et al

223

9.43 years

NO

15-year

[68]

85.60%

80.30%

67.80%

Stock et al

181

65 months

YES

8-year

[69]

73%

Wernicke et al

242

10 years

NO

10-year

[70]

77.30%

-

Table 2. Combination of LDR brachytherapy and EBRT

Table 2. Combination of LDR brachytherapy and EBRT

0 0

Post a comment