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Evaluating Local Doses for Prostate Cancer Treatment Using Low-Dose-Rate Brachytherapy Considering Oncological

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For prostate cancer patients treated with low-dose-rate brachytherapy (LDR-BT) alone, a biologically effective dose (BED) of 180-200 Gy2 optimizes outcomes. Combining LDR-BT with external beam radiation therapy (EBRT) suggests a BED of 200-220 Gy2 may be more appropriate for managing clinical failure and toxicity.

Keywords:
brachytherapyoncological controlprostate cancerradiation dosagetoxicity

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Urologic Oncology

Background:

  • Evaluating treatment efficacy and toxicity in prostate cancer is crucial for optimizing patient outcomes.
  • Low-dose-rate brachytherapy (LDR-BT) and external beam radiation therapy (EBRT) are established treatment modalities.
  • Understanding the relationship between radiation dose and clinical outcomes is essential for personalized treatment planning.

Purpose of the Study:

  • To identify factors associated with clinical failure and toxicity in prostate cancer patients.
  • To determine optimal biologically effective dose (BED) thresholds for LDR-BT alone and combined with EBRT.
  • To establish BED cut-off values for predicting Grade 3 or higher toxicity.

Main Methods:

  • A cohort of 713 patients treated with LDR-BT alone and 534 patients treated with LDR-BT combined with EBRT were analyzed.
  • The Fine-Gray hazard model was used to assess factors related to clinical failure.
  • The Youden index was employed to determine BED cut-off values for toxicity.

Main Results:

  • For LDR-BT alone, BED thresholds of ≥180 Gy2 were associated with better clinical outcomes in low- and intermediate-risk patients.
  • A BED of 200 Gy2 was identified as a toxicity cut-off for LDR-BT alone.
  • For LDR-BT combined with EBRT, BED was not significantly associated with improved failure-free rates, but a BED cut-off of 220 Gy2 was determined for toxicity.

Conclusions:

  • A BED of 180-200 Gy2 appears optimal for prostate cancer treated with LDR-BT alone.
  • For combined LDR-BT and EBRT, a BED of 200-220 Gy2 may be more appropriate to balance efficacy and toxicity.
  • These findings support dose optimization in radiation therapy for prostate cancer.