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Building a High-Dose-Rate Prostate Brachytherapy Program With Real-Time Ultrasound-Based Planning: Initial Safety,

Hong Zhang1, Sohyun Kang1, Naba Ali1

  • 1Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York.

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High-dose-rate (HDR) brachytherapy is a safe and effective treatment for localized prostate cancer. A new HDR program showed excellent short-term outcomes, including high survival rates and low toxicity.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Urology

Background:

  • High-dose-rate (HDR) brachytherapy is increasingly recognized for its efficacy and safety in prostate cancer treatment, serving as either a standalone therapy or a boost.
  • Establishing a new HDR brachytherapy program requires careful evaluation of its initial learning curve, safety profile, and patient outcomes.

Purpose of the Study:

  • To report the learning experiences, short-term safety, quality, and outcomes of a newly established high-dose-rate (HDR) brachytherapy program for prostate cancer.
  • To assess the feasibility and effectiveness of HDR brachytherapy as a treatment option for localized prostate cancer.

Main Methods:

  • A cohort of 164 men with prostate cancer were treated with curative-intent HDR brachytherapy between April 2014 and December 2017.
  • Patients received HDR brachytherapy as monotherapy (25-27 Gy in 2 fractions) or as a boost (19-21 Gy in 2 fractions), with detailed recording of procedure times, dosimetry, and genitourinary (GU) and gastrointestinal (GI) toxicities.

Main Results:

  • Mean HDR procedure times significantly decreased from 179 minutes in 2014 to 115 minutes in 2017.
  • At a median follow-up of 18.6 months, 79% of patients returned to baseline GU function, and 100% maintained baseline GI status, with a low incidence of acute urinary retention.
  • Excellent dosimetric coverage was achieved (e.g., 97.5% PTV D90 ≥100%), and estimated 3-year overall and disease-free survival rates were 98.7% and 96.2%, respectively.

Conclusions:

  • The successful development of this HDR brachytherapy program demonstrates its viability as a treatment option for localized prostate cancer.
  • Low rates of GU and GI complications observed in this cohort highlight the safety and efficacy of HDR brachytherapy when implemented effectively.