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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

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High Dose Rate Brachytherapy in High-Risk Localised Disease - Why Do Anything Else?

G C Morton¹, S M Alrashidi¹

¹Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.

Clinical Oncology (Royal College of Radiologists (Great Britain))

|December 4, 2019

Summary

High-risk prostate cancer patients benefit from high dose rate (HDR) brachytherapy boost alongside external beam radiotherapy. This approach improves local control and survival, establishing it as a standard treatment option.

Keywords:

Brachytherapy high dose rate high risk prostate cancer

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Area of Science:

Oncology
Radiation Oncology
Urologic Oncology

Background:

High-risk prostate cancer management is complex due to high relapse rates.
Adjuvant systemic therapy is crucial, but local treatment optimization is key for radiotherapy patients.
Brachytherapy boost, either low dose rate (LDR) or high dose rate (HDR), is vital for local control.

Purpose of the Study:

To evaluate the efficacy and safety of HDR brachytherapy as a boost to external beam radiotherapy for high-risk prostate cancer.
To compare HDR brachytherapy outcomes with LDR brachytherapy and external beam radiotherapy alone.

Main Methods:

Review of evidence from randomized clinical trials, meta-analyses, and cohort studies.
Analysis of data comparing HDR brachytherapy combined with pelvic external beam radiotherapy versus external beam radiotherapy alone.
Assessment of local disease control, metastasis rates, and cancer-specific survival.

Main Results:

HDR brachytherapy offers advantages over LDR, including consistent dose optimization, extra-prostatic treatment capability, and reduced toxicity.
Evidence supports HDR brachytherapy boost improving local disease control in high-risk prostate cancer.
Studies indicate potential reduction in metastases and improved cancer-specific survival compared to external beam radiotherapy alone.

Conclusions:

High dose rate brachytherapy boost, combined with pelvic external beam radiotherapy, is a highly effective treatment for high-risk prostate cancer.
This combined approach demonstrates improved outcomes and should be considered standard care.
HDR brachytherapy offers superior dose optimization and lower toxicity compared to LDR brachytherapy.