Prostate Cancer Patients Satisfied With HDR Brachytherapy

Roxanne Nelson, BSN, RN

May 09, 2017

VIENNA ― High-dose-rate brachytherapy (HDR-BT) appears to be a safe and well tolerated option for treating prostate cancer, and importantly, there was high patient satisfaction with the procedure, say researchers from Spain. However, it is too early for efficacy results, and this procedure should at present be used only in clinical trials, they add.

"To the patient, the main advantage is to get the radiotherapy in just one day. Although the brachytherapy is done in an operating room, it is an outpatient procedure, and the patient avoids daily radiation treatment," said lead author Alfonso Gomez-Iturriaga, MD, from the Hospital de Cruces, Baracaldo, Spain.

"The combination of a short lapse of time, real-time 3D visualization of the target and needles positioned using ultrasound, and the ability to optimize the dose allow for an extraordinary control over the dose administration," he added.

Presenting new data here at the European Society for Radiotherapy & Oncology (ESTRO 2017), the researchers said that HDR-BT demonstrated excellent results in terms of toxicity, tolerance, safety, patient satisfaction, and quality of life, which were the primary endpoints of the study.

"Our study demonstrates that patients do not suffer higher toxicity or a worse quality of life than might be expected with other methods of delivering radiation treatment," they said.

"In fact, patients are very satisfied with this single outpatient treatment, which they find convenient and which allows them to return rapidly to normal activities," they added.

At a median follow-up of 16 months, none of the 45 patients enrolled in the study had experienced grade 3 or higher adverse events.

Of the patients who had normal sexual functioning prior to beginning treatment, 60% retained their potency.

Six months after their treatment ended, more than three quarters (77%) of the cohort reported that they were "extremely satisfied" with their treatment and quality of life; 23% said they were "very satisfied."

However, Dr Gomez-Iturraga emphasized that even though it seems clear that toxicity and negative impact on quality of life are quite low, it is too soon to say that HDR-BT can be used outside of clinical trials. "Longer follow-up for at least 5 years is needed to demonstrate definite cancer control," he said.

Low Toxicity, Improved QoL

It has been hypothesized that the use of HDR-BT in prostate cancer could prove to be more advantageous to patients and reduce costs, as compared with low-dose-rate BT (seeds) and external-beam radiotherapy. Although some evidence supports its use as monotherapy for selected patients with low- and intermediate-risk prostate cancer when administered in four or more fractions, the authors point out that data on safety and efficacy of HDR given in a single fraction are limited.

In this study, Dr Gomez-Iturraga and colleagues evaluated HDR-BT in 45 prostate cancer patients who were treated at their facility in January 2014 and July 2016.

All patients had low-risk (44%) or intermediate-risk (56%) disease, were treatment naive, and were experiencing mild to moderate symptoms. For all patients, tumor volume was ≤60 cc (median volume, 34 cc).

HDR-BT was delivered in a single fraction of 19Gy.

The patients were monitored prospectively for toxicity and health-related quality of life using the Expanded Prostate Cancer Index Composite (EPIC) tool.

At follow-up, four patients (9%) experienced acute grade 2 genitourinary toxicity, and two patients (2.3%) had grade 2 gastrointestinal toxicity.

For quality of life, the authors note that there was a statistically significant reduction in the EPIC urinary urgency domain between month 1 and month 6 (P = .006). Urinary urgency returned to baseline by month 12. There were no significant changes in mean EPIC urinary irritative-obstructive, bowel, sexual, and hormonal domains.

Commenting on the new study, Yolande Lievens, MD, president of ESTRO and head of the Department of Radiation Oncology at Ghent University Hospital, Belgium, said: "As radiation oncologists, we are working constantly to try to reduce the impact of radiation therapy on patients' lives while maintaining and improving the efficacy of the treatment."

She noted that even though these findings are early and it is too soon to confirm the efficacy of the treatment, "they suggest that it may be possible to reduce the number of trips to hospital for patients."

In addition to making treatment more convenient for the patient, it is also possible to target the tumor more precisely and thus avoid adverse side effects. "However, we need to follow these patients for longer to ensure the cancer continues to be controlled successfully," said Dr Lievens.

European Society for Radiotherapy & Oncology (ESTRO 2017). Abstract OC-0270, presented May 9, 2017.

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