Combined modality treatment with high-dose-rate brachytherapy boost for locally advanced prostate cancer

Purpose This is a retrospective review of our experience using high-dose-rate (HDR) brachytherapy boost for prostate cancer. Methods and materials During the study period, we recommended external beam radiotherapy (45 Gy) and HDR boost (18 Gy in three fractions) combined with hormonal therapy (HT) for 2 months before and during radiotherapy to patients with at least one of the following risk features: pretreatment prostate-specific antigen >10, Gleason score (GS) ≥7, and clinical T3 disease. Additional HT for 2 years after radiotherapy was recommended for patients with GS >7. To patients whose risk of positive nodes exceeded 15%, we recommended whole pelvic radiotherapy. We administered HDR via single implant, and all fractions were given within 24 h. Results This report is based on our initial 64 patients treated with HDR boost. The median follow-up was 50 months (range 25–68 months). The 4-year estimates of overall and disease-free survival were 98% and 92%, respectively. One patient experienced late grade 4 gastrointestinal toxicity. Conclusions HDR brachytherapy is an effective means of delivering conformal prostate radiotherapy, and may be used with whole pelvic radiotherapy and HT.