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High-Dose-Rate Brachytherapy as Monotherapy for Prostate Cancer

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Brachytherapy

Abstract

High-dose-rate (HDR) brachytherapy as monotherapy for prostate cancer has theoretical advantages in both aspects of radiation physics and biology compared to other radiotherapy modalities. The three-dimensional and four-dimensional dose distribution of HDR brachytherapy is superb, and HDR monotherapy maximizes the biological dose escalation. In the former part of this chapter, techniques in implant and treatment planning of HDR monotherapy are mentioned, followed by it’s theoretical advantages. In the latter half, clinical evidence of HDR monotherapy is overviewed along with its history over 20 years. Since its dawning with four- to nine-fraction regimens, HDR monotherapy has been moving on to more and more hypofractionated regimens. The latest two- or single-fraction HDR monotherapy is vigorously discussed.

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References

  1. Kovács G, Pötter R, Loch T, et al. GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer. Radiother Oncol. 2005;74:137–48.

    Article  PubMed  Google Scholar 

  2. Hoskin PJ, Colombo A, Henry A, et al. GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: an update. Radiother Oncol. 2013;107:325–32.

    Article  PubMed  Google Scholar 

  3. Yamada Y, Rogers L, Demanes DJ, et al. American brachytherapy society. American brachytherapy society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy. 2012;11:20–32.

    Article  PubMed  Google Scholar 

  4. Chin J, Rumble RB, Kollmeier M, et al. Brachytherapy for patients with prostate cancer: American Society of Clinical Oncology/Cancer Care Ontario joint guideline update. J Clin Oncol. 2017;35:1737–43.

    Article  PubMed  Google Scholar 

  5. Hsu IC, Yamada Y, Assimos DG, et al. ACR appropriateness criteria high-dose-rate brachytherapy for prostate cancer. Brachytherapy. 2014;13:27–31.

    Article  PubMed  Google Scholar 

  6. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. Prostate Cancer. Version 2.2017. http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed 4 Oct 2017.

  7. Yoshioka Y, Yoshida K, Yamazaki H, et al. The emerging role of high-dose-rate (HDR) brachytherapy as monotherapy for prostate cancer. J Radiat Res. 2013;54:781–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Skowronek J. Low-dose-rate or high-dose-rate brachytherapy in treatment of prostate cancer – between options. J Contemp Brachytherapy. 2013;5:33–41.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zaorsky NG, Doyle LA, Hurwitz MD, et al. Do theoretical potential and advanced technology justify the use of high-dose rate brachytherapy as monotherapy for prostate cancer? Expert Rev Anticancer Ther. 2014;14:39–50.

    Article  CAS  PubMed  Google Scholar 

  10. Yoshioka Y, Suzuki O, Otani Y, et al. High-dose-rate brachytherapy as monotherapy for prostate cancer: technique, rationale and perspective. J Contemp Brachytherapy. 2014;6:91–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Demanes DJ, Ghilezan MI. High-dose-rate brachytherapy as monotherapy for prostate cancer. Brachytherapy. 2014;13:529–41.

    Article  PubMed  Google Scholar 

  12. Zaorsky NG, Davis BJ, Nguyen PL, et al. The evolution of brachytherapy for prostate cancer. Nat Rev Urol. 2017;14:415–39.

    Article  PubMed  Google Scholar 

  13. Georg D, Hopfgartner J, Gòra J, et al. Dosimetric considerations to determine the optimal technique for localized prostate cancer among external photon, proton, or carbon-ion therapy and high-dose-rate or low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2014;88:715–22.

    Article  PubMed  Google Scholar 

  14. Grills IS, Martinez AA, Hollander M, et al. High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds. J Urol. 2004;171:1098–104.

    Article  PubMed  Google Scholar 

  15. Damore SJ, Syed AM, Puthawala AA, et al. Needle displacement during HDR brachytherapy in the treatment of prostate cancer. Int J Radiat Oncol Biol Phys. 2000;46:1205–11.

    Article  CAS  PubMed  Google Scholar 

  16. Hoskin PJ, Bownes PJ, Ostler P, et al. High dose rate after loading brachytherapy for prostate cancer: catheter and gland movement between fractions. Radiother Oncol. 2003;68:285–8.

    Article  PubMed  Google Scholar 

  17. Mullokandov E, Gejerman G. Analysis of serial CT scans to assess template and catheter movement in prostate HDR brachytherapy. Int J Radiat Oncol Biol Phys. 2004;58:1063–71.

    Article  PubMed  Google Scholar 

  18. Simnor T, Li S, Lowe G, et al. Justification for inter-fraction correction of catheter movement in fractionated high dose-rate brachytherapy treatment of prostate cancer. Radiother Oncol. 2009;93:253–8.

    Article  PubMed  Google Scholar 

  19. Yoshida K, Yamazaki H, Nose T, et al. Needle applicator displacement during high-dose-rate interstitial brachytherapy for prostate cancer. Brachytherapy. 2010;9:36–41.

    Article  PubMed  Google Scholar 

  20. Foster W, Cunha JA, Hsu IC, et al. Dosimetric impact of interfraction catheter movement in high-dose rate prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2011;80:85–90.

    Article  PubMed  Google Scholar 

  21. Kolkman-Deurloo IK, Roos MA, Aluwini S. HDR monotherapy for prostate cancer: a simulation study to determine the effect of catheter displacement on target coverage and normal tissue irradiation. Radiother Oncol. 2011;98:192–7.

    Article  PubMed  Google Scholar 

  22. Konishi K, Yoshioka Y, Isohashi F, et al. Correlation between dosimetric parameters and late rectal and urinary toxicities in patients treated with high-dose-rate brachytherapy used as monotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2009;75:1003–7.

    Article  PubMed  Google Scholar 

  23. Yoshida K, Kuroda S, Yoshida M, et al. New implant technique for separation of the seminal vesicle and rectal mucosa for high-dose-rate prostate brachytherapy. Brachytherapy. 2007;6:180–6.

    Article  PubMed  Google Scholar 

  24. Yoshioka Y, Nishimura T, Kamata M, et al. Evaluation of anatomy-based dwell position and inverse optimization in high-dose-rate brachytherapy of prostate cancer: a dosimetric comparison to a conventional cylindrical dwell position, geometric optimization, and dose-point optimization. Radiother Oncol. 2005;75:311–7.

    Article  PubMed  Google Scholar 

  25. Sumida I, Shiomi H, Yoshioka Y, et al. Optimization of dose distribution for HDR brachytherapy of the prostate using attraction-repulsion model. Int J Radiat Oncol Biol Phys. 2006;64:643–9.

    Article  PubMed  Google Scholar 

  26. Brenner DJ, Hall EJ. Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys. 1999;43:1095–101.

    Article  CAS  PubMed  Google Scholar 

  27. Fowler J, Chappell R, Ritter M. Is alpha/beta for prostate tumors really low? Int J Radiat Oncol Biol Phys. 2001;50:1021–31.

    Article  CAS  PubMed  Google Scholar 

  28. Brenner DJ, Martinez AA, Edmundson GK, et al. Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue. Int J Radiat Oncol Biol Phys. 2002;52:6–13.

    Article  PubMed  Google Scholar 

  29. Wang JZ, Guerrero M, Li XA. How low is the alpha/beta ratio for prostate cancer? Int J Radiat Oncol Biol Phys. 2003;55:194–203.

    Article  PubMed  Google Scholar 

  30. Miralbell R, Roberts SA, Zubizarreta E, et al. Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: α/β = 1.4 (0.9-2.2) Gy. Int J Radiat Oncol Biol Phys. 2012;82:e17–24.

    Article  PubMed  Google Scholar 

  31. Miyakawa A, Shibamoto Y, Otsuka S, et al. Applicability of the linear-quadratic model to single and fractionated radiotherapy schedules: an experimental study. J Radiat Res. 2014;55:451–4.

    Article  PubMed  Google Scholar 

  32. Brenner DJ. The linear-quadratic model is an appropriate methodology for determining isoeffective doses at large doses per fraction. Semin Radiat Oncol. 2008;18:234–9.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yoshioka Y, Nose T, Yoshida K, et al. High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial. Int J Radiat Oncol Biol Phys. 2000;48:675–81.

    Article  CAS  PubMed  Google Scholar 

  34. Yoshioka Y, Nose T, Yoshida K, et al. High-dose-rate brachytherapy as monotherapy for localized prostate cancer: a retrospective analysis with special focus on tolerance and chronic toxicity. Int J Radiat Oncol Biol Phys. 2003;56:213–20.

    Article  PubMed  Google Scholar 

  35. Yoshioka Y, Konishi K, Oh RJ, et al. High-dose-rate brachytherapy without external beam irradiation for locally advanced prostate cancer. Radiother Oncol. 2006;80:62–8.

    Article  PubMed  Google Scholar 

  36. Yoshioka Y, Konishi K, Sumida I, et al. Monotherapeutic high-dose-rate brachytherapy for prostate cancer: five-year results of an extreme hypofractionation regimen with 54 Gy in nine fractions. Int J Radiat Oncol Biol Phys. 2011;80:469–75.

    Article  PubMed  Google Scholar 

  37. Yoshioka Y, Konishi K, Suzuki O, et al. Monotherapeutic high-dose-rate brachytherapy for prostate cancer: a dose reduction trial. Radiother Oncol. 2014;110:114–9.

    Article  PubMed  Google Scholar 

  38. Yoshioka Y, Suzuki O, Isohashi F, et al. High-dose-rate brachytherapy as monotherapy for intermediate- and high-risk prostate cancer: clinical results for a median 8-year follow-up. Int J Radiat Oncol Biol Phys. 2016;94:675–82.

    Article  PubMed  Google Scholar 

  39. Yoshida K, Yamazaki H, Takenaka T, et al. High-dose-rate interstitial brachytherapy in combination with androgen deprivation therapy for prostate cancer: are high-risk patients good candidates? Strahlenther Onkol. 2014;195:1015–20.

    Article  Google Scholar 

  40. Yoshioka Y, Kotsuma T, Komiya A, et al. Nationwide, multicenter, retrospective study on high-dose-rate brachytherapy as monotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2017;97:952–61.

    Article  PubMed  Google Scholar 

  41. Demanes DJ, Martinez AA, Ghilezan M, et al. High-dose-rate monotherapy: safe and effective brachytherapy for patients with localized prostate cancer. Int J Radiat Oncol Biol Phys. 2011;81:1286–92.

    Article  PubMed  Google Scholar 

  42. Hauswald H, Kamrava MR, Fallon JM, et al. High-dose-rate monotherapy for localized prostate cancer: 10-year results. Int J Radiat Oncol Biol Phys. 2016;94:667–74.

    Article  PubMed  Google Scholar 

  43. Martinez A, Pataki I, Edmundson G, et al. Phase II prospective study of the use of conformal high-dose-rate brachytherapy as monotherapy for the treatment of favorable stage prostate cancer: a feasibility report. Int J Radiat Oncol Biol Phys. 2001;49:61–9.

    Article  CAS  PubMed  Google Scholar 

  44. Martinez AA, Demanes J, Vargas C, et al. High dose rate prostate brachytherapy: an excellent accelerated hypofractionated treatment for favourable prostate cancer. Am J Clin Oncol. 2010;33:481–8.

    Article  PubMed  Google Scholar 

  45. Martin T, Baltas D. Kureck R, et al. 3D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study. Strahlenther Oncol. 2004;180:225–32.

    Article  Google Scholar 

  46. Ghadjar P, Keller T, Pentsch CA, et al. Toxicity and early treatment outcomes in low and intermediate-risk prostate cancer managed by high-dose rate brachytherapy as monotherapy. Brachytherapy. 2009;8:45–51.

    Article  PubMed  Google Scholar 

  47. Rogers CL, Alder SC, Rogers RL, et al. High dose brachytherapy as monotherapy for intermediate risk prostate cancer. J Urol. 2012;187:109–16.

    Article  PubMed  Google Scholar 

  48. Barkati M, Williams SG, Foroudi F, et al. High-dose-rate brachytherapy as a monotherapy for favorable-risk prostate cancer: a phase II trial. Int J Radiat Oncol Biol Phys. 2012;82:1889–96.

    Article  PubMed  Google Scholar 

  49. Zamboglou N, Tselis N, Baltas D, et al. High-dose-rate interstitial brachytherapy as monotherapy for clinically localized prostate cancer: treatment evolution and mature results. Int J Radiat Oncol Biol Phys. 2013;85:672–8.

    Article  PubMed  Google Scholar 

  50. Strouthos I, Tselis N, Chatzikonstantinou G, et al. High dose rate brachytherapy as monotherapy for localised prostate cancer. Radiother Oncol. 2018;126:270–7.

    Article  PubMed  Google Scholar 

  51. Kukiełka AM, Dąbrowski T, Walasek T, et al. High-dose-rate brachytherapy as a monotherapy for prostate cancer--single-institution results of the extreme fractionation regimen. Brachytherapy. 2015;14:359–65.

    Article  PubMed  Google Scholar 

  52. Corner C, Rajas AM, Bryant L, et al. A phase II study of high dose rate afterloading brachytherapy as monotherapy for the treatment of localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;72:441–6.

    Article  PubMed  Google Scholar 

  53. Hoskin P, Rojas A, Lowe G, et al. High-dose-rate brachytherapy alone for localized prostate cancer in patients at moderate or high risk of biochemical recurrence. Int J Radiat Oncol Biol Phys. 2012;82:1376–84.

    Article  PubMed  Google Scholar 

  54. Hoskin P, Rojas A, Ostler P, et al. High-dose-rate brachytherapy with two or three fractions as monotherapy in the treatment of locally advanced prostate cancer. Radiother Oncol. 2014;112:63–7.

    Article  PubMed  Google Scholar 

  55. Hoskin P, Rojas A, Ostler P, et al. High-dose-rate brachytherapy alone given as two or one fraction to patients for locally advanced prostate cancer: acute toxicity. Radiother Oncol. 2014;110:268–71.

    Article  PubMed  Google Scholar 

  56. Hoskin P, Rojas A, Ostler P, et al. Single-dose high-dose-rate brachytherapy compared to two and three fractions for locally advanced prostate cancer. Radiother Oncol. 2017;124:56–60.

    Article  PubMed  Google Scholar 

  57. Ghilezan M, Martinez A, Gustason G, et al. High-dose-rate brachytherapy as monotherapy delivered in two fractions within one day for favorable/intermediate-risk prostate cancer: preliminary toxicity data. Int J Radiat Oncol Biol Phys. 2012;83:927–32.

    Article  PubMed  Google Scholar 

  58. Jawad MS, Dilworth JT, Gustafson GS, et al. Outcomes associated with 3 treatment schedules of high-dose-rate brachytherapy monotherapy for favorable-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2016;94:657–66.

    Article  PubMed  Google Scholar 

  59. Prada PJ, Jimenez I, González-Suárez H, et al. High-dose-rate interstitial brachytherapy as monotherapy in one fraction and transperineal hyaluronic acid injection into the perirectal fat for the treatment of favorable stage prostate cancer: treatment description and preliminary results. Brachytherapy. 2012;11:105–10.

    Article  PubMed  Google Scholar 

  60. Prada PJ, Cardenal J, Blanco AG, et al. High-dose-rate interstitial brachytherapy as monotherapy in one fraction for the treatment of favorable stage prostate cancer: toxicity and long-term biochemical results. Radiother Oncol. 2016;119:411–6.

    Article  PubMed  Google Scholar 

  61. Morton G, Chung HT, McGuffin M, et al. Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: early toxicity and quality-of life results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy. Radiother Oncol. 2017;122:87–92.

    Article  PubMed  Google Scholar 

  62. Mendez LC, Ravi A, Chung H, et al. Pattern of relapse and dose received by the recurrent intraprostatic nodule in low- to intermediate-risk prostate cancer treated with single fraction 19 Gy high-dose-rate brachytherapy. Brachytherapy. 2018;17:291–7.

    Article  PubMed  Google Scholar 

  63. Krauss DJ, Ye H, Martinez AA, et al. Favorable preliminary outcomes for men with low- and intermediate-risk prostate cancer treated with 19-Gy single-fraction high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2017;97:98–106.

    Article  PubMed  Google Scholar 

  64. Major T, Polgár C, Jorgo K, et al. Dosimetric comparison between treatment plans of patients treated with low-dose-rate vs. high-dose-rate interstitial prostate brachytherapy as monotherapy: initial findings of a randomized clinical trial. Brachytherapy. 2017;16:608–15.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Yasuo Yoshioka, Minako Sumi & Masahiko Oguchi

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  1. Yasuo Yoshioka
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  2. Minako Sumi
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  3. Masahiko Oguchi
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Correspondence to Yasuo Yoshioka .

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Editors and Affiliations

  1. Radiation Oncology Department, The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan

    Yasuo Yoshioka

  2. Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan

    Jun Itami

  3. Radiation Oncology Department, The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan

    Masahiko Oguchi

  4. Department of Radiation Oncology, Gunma University, Maebashi, Gunma, Japan

    Takashi Nakano

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Yoshioka, Y., Sumi, M., Oguchi, M. (2019). High-Dose-Rate Brachytherapy as Monotherapy for Prostate Cancer. In: Yoshioka, Y., Itami, J., Oguchi, M., Nakano, T. (eds) Brachytherapy. Springer, Singapore. https://doi.org/10.1007/978-981-13-0490-3_13

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  • DOI: https://doi.org/10.1007/978-981-13-0490-3_13

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