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High-Dose-Rate Brachytherapy Boost for Prostate Cancer: A Retrospective Observational Study in Low- and Middle-Income
Hamza Samlali1, Najlaa Assaid1, Youness Khobbaizi1
1Radiation Oncology Department, Littoral Clinic, Oncorad Group, Casablanca, Morocco.
Purpose:
Prostate brachytherapy used as an adjunct to external beam radiation therapy is recognized as an effective therapeutic approach in the treatment of intermediate and high-risk prostate cancer. However, data remain limited in African countries, particularly Morocco. The aim of this study was to assess the oncological outcomes and tolerability of boost brachytherapy in a Moroccan cohort.
Methods And Materials:
A retrospective study was conducted between 2014 and 2022. Among 128 patients treated with prostate brachytherapy, 106 with intermediate- or high-risk prostate cancer who received high-dose-rate brachytherapy as a boost were included. Hormone therapy was administered to 84.91% of patients. Median follow-up was 26 months. Clinical characteristics, dosimetric data, toxicity, and oncological results were analyzed.
Results:
Of the 106 patients, 59 (55.66%) had intermediate-risk cancer and 47 (44.34%) had high-risk cancer. Locally advanced stage (T3a-T3b) was observed in 43.4% of patients. At 3 years, overall survival, metastasis-free survival (MFS), and biochemical progression-free survival (BPFS) were 87%, 92%, and 78%, respectively. The 3-year BPFS was 75% for intermediate-risk cancers and 70% for high-risk cancers. International Society of Urological Pathology (ISUP)scores 1 to 3 showed better BPFS (85%) and MFS (92%) than ISUP scores 4 to 5 (BPFS: 60%, MFS: 79%). Clinical stage was the only significant factor for MFS (P = .001). No grade 3 acute toxicities (genitourinary or gastrointestinal) were reported. Late grade 3 toxicities were observed in 1.89% (genitourinary) and 0.94% (gastrointestinal) of patients. Grade 2 toxicities remained low (<9%).
Conclusions:
This single-center study confirms the efficacy and tolerability of the combination of external beam radiation therapy and brachytherapy in the treatment of intermediate- and high-risk prostate cancer. The results are encouraging, even in advanced-stage patients. Clinical stage has been shown to be the main prognostic factor for MFS.
