Prostate Cancer Patients At Risk of Local Extension Benefit from Brachytherapy
Recent results published in the American Cancer Society’s journal Cancer suggest that a combination of external beam radiation therapy and brachytherapy improve disease control for prostate cancer patients at increased risk for extracapsular cancer extension (ECE).
The team reviewed outcomes for 282 patients, consecutively treated over a five year period, in Sarasota at the Dattoli Cancer Center and Brachytherapy Research Institute. 243 of those patients had at least one factor that increased their risk of developing ECE; 119 of those had intermediate- and 124 had high-risk disease according to the grading system from the National Comprehensive Cancer Network. Confirmation of pathology was completed by independent pathologists at the University of Washington.
Patients received 3-d conformal external beam radiation therapy to the pelvis with a Pd-103 boost. Margins for the treatment with brachytherapy were generous. The average follow up period was 9.5 years.
81 percent of patients were without biochemical disease progression during the follow-up period. With respect to stratification by risk, 72 percent of high-risk and 87 percent with intermediate risk had not progressed. The risk of failure, in absolute terms, was 1 percent at six years of follow-up. Patients who failed therapy underwent biopsy, none of which revealed any local disease recurrence.
The strongest predictors of failure were Gleason score, followed by PSA. Both were statistically significant. Limited adverse events were noted with this treatment approach; those noted were gastrointestinal and urinary symptoms.
The team argued that radiation followed by brachytherapy provides good local disease control in both high- and intermediate-risk prostate cancer patients. These findings are contrary to the often held perception that patients at risk of ECE should not be treated with brachytherapy. Future studies, based on this approach, may alter the standard of care for treating this patient population.
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August 29, 2007 Related topics: Radiology, Hematology & Oncology