High-Dose-Rate Brachytherapy Alone for Localized Prostate Cancer in Patients at Moderate or High Risk of Biochemical Recurrence


      To evaluate genitourinary (GU) and gastrointestinal (GI) morbidity and biochemical control of disease in patients with localized prostate adenocarcinoma treated with escalating doses per fraction of high-dose rate brachytherapy alone.

      Methods and Materials

      A total of 197 patients were treated with 34 Gy in four fractions, 36 Gy in four fractions, 31.5 Gy in three fractions, or 26 Gy in two fractions. Median follow-up times were 60, 54, 36, and 6 months, respectively.


      Incidence of early Grade ≥ 3 GU morbidity was 3% to 7%, and Grade 4 was 0% to 4%. During the first 12 weeks, the highest mean International Prostate Symptom Score (IPSS) value was 14, and between 6 months and 5 years it was 8. Grade 3 or 4 early GI morbidity was not observed. The 3-year actuarial rate of Grade 3 GU was 3% to 16%, and was 3% to 7% for strictures requiring surgery (4-year rate). An incidence of 1% Grade 3 GI events was seen at 3 years. Late Grade 4 GU or GI events were not observed. At 3 years, 99% of patients with intermediate-risk and 91% with high-risk disease were free of biochemical relapse (log-rank p = 0.02).


      There was no significant difference in urinary and rectal morbidity between schedules. Biochemical control of disease in patients with intermediate and high risk of relapse was good.
      To read this article in full you will need to make a payment
      ASTRO Member Login
      ASTRO Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Koukourakis G.
        • Kelekis N.
        • Armonis V.
        • et al.
        Brachytherapy for prostate cancer: A systematic review.
        Adv Urol. 2009; : 327945
        • Yoshioka Y.
        • Konishi K.
        • Oh R.J.
        • et al.
        High-dose-rate brachytherapy without external beam irradiation for locally advanced prostate cancer.
        Radiother Oncol. 2006; 80: 62-68
        • Morton G.C.
        The emerging role of high-dose-rate brachytherapy for prostate cancer.
        Clin Oncol (R Coll Radiol). 2005; 17: 219-227
        • Demanes D.J.
        • Gilhezan M.
        • Schour L.
        • et al.
        High dose rate brachytherapy (HDR-BT) as monotherapy for favorable prostate cancer: Excellent 5-year control rates and low toxicity.
        Int J Radiat Oncol Biol Phys. 2007; 69: S83
        • Ghadjar P.
        • Keller T.
        • Rentsch C.A.
        • et al.
        Toxicity and early treatment outcomes in low- and intermediate-risk prostate cancer managed by high-dose-rate brachytherapy as a monotherapy.
        Brachytherapy. 2009; 8: 45-51
        • Ghilezan M.
        HDR vs LDR (Pd103 permanent implants) brachytherapy as monotherapy for prostate cancer. Timing of on set and predictors of erectile dysfunction.
        J Clin Oncol. 2005; ((poster presentation) ())
        • Ghilezan M.
        • Gustafson G.
        • Fontanesi J.
        • et al.
        High-dose-rate brachytherapy as monotherapy delivered in two fractions over one day for favorable-risk prostate cancer. Preliminary toxicity data.
        Brachytherapy. 2009; 8: 176
        • Grills I.S.
        • Martinez A.A.
        • Hollander M.
        • et al.
        High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds.
        J Urol. 2004; 171: 1098-1104
        • Konishi K.
        • Yoshioka Y.
        • Isohashi F.
        • et al.
        Correlation between dosimetric parameters and late rectal and urinary toxicities in patients treated with high-dose-rate brachytherapy used as monotherapy for prostate cancer.
        Int J Radiat Oncol Biol Phys. 2009; 75: 1003-1007
        • Mark R.J.
        • Akins R.S.
        • Anderson P.J.
        • et al.
        Interstitial high dose rate (HDR) brachtherapy as monotherapy for early stage prostate cancer: A report of 206 cases.
        Int J Radiat Oncol Biol Phys. 2007; 69: S329
        • Mark R.J.
        • Anderson P.J.
        • Akins R.S.
        • et al.
        Interstitial high-dose-rate brachytherapy as monotherapy for early stage prostate cancer: Median 8-year results in 301 patients.
        Brachytherapy. 2010; 9: S76
        • Martin T.
        • Baltas D.
        • Kurek R.
        • et al.
        3-D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study.
        Strahlenther Onkol. 2004; 180: 225-232
        • Martinez A.A.
        • Demanes J.
        • Vargas C.
        • et al.
        High-dose-rate prostate brachytherapy: An excellent accelerated-hypofractionated treatment for favorable prostate cancer.
        Am J Clin Oncol. 2010; 33: 481-488
        • Rogers L.
        • Hayes J.
        • Childs L.
        • et al.
        High dose rate brachytherapy as monotherapy for clinically localized prostate cancer.
        Int J Radiat Oncol Biol Phys. 2006; 66: S377-S378
        • Sullivan L.
        • Williams S.G.
        • Tai K.H.
        • et al.
        Urethral stricture following high dose rate brachytherapy for prostate cancer.
        Radiother Oncol. 2009; 91: 232-236
        • Brenner D.J.
        • Martinez A.A.
        • Edmundson G.K.
        • et al.
        Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue.
        Int J Radiat Oncol Biol Phys. 2002; 52: 6-13
        • Fowler J.
        • Chappell R.
        • Ritter M.
        Is alpha/beta for prostate tumors really low?.
        Int J Radiat Oncol Biol Phys. 2001; 50: 1021-1031
        • Dasu A.
        Is the alpha/beta value for prostate tumours low enough to be safely used in clinical trials?.
        Clin Oncol (R Coll Radiol). 2007; 19: 289-301
        • Shaffer R.
        • Pickles T.
        • Lee R.
        • et al.
        Deriving prostate alpha-beta ratio using carefully matched groups, long follow-up and the Phoenix Definition of Biochemical Failure.
        Int J Radiat Oncol Biol Phys. 2011; 79: 1029-1036
        • Valdagni R.
        • Italia C.
        • Montanaro P.
        • et al.
        Is the alpha-beta ratio of prostate cancer really low? A prospective, non-randomized trial comparing standard and hyperfractionated conformal radiation therapy.
        Radiother Oncol. 2005; 75: 74-82
        • Corner C.
        • Rojas A.M.
        • Bryant L.
        • et al.
        A Phase II study of high-dose-rate afterloading brachytherapy as monotherapy for the treatment of localized prostate cancer.
        Int J Radiat Oncol Biol Phys. 2008; 72: 441-446
        • Simnor T.
        • Li S.
        • Lowe G.
        • et al.
        Justification for inter-fraction correction of catheter movement in fractionated high dose-rate brachytherapy treatment of prostate cancer.
        Radiother Oncol. 2009; 93: 253-258
        • Nag S.
        • Ellis R.J.
        • Merrick G.S.
        • et al.
        American Brachytherapy Society recommendations for reporting morbidity after prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 2002; 54: 462-470
        • Roach 3rd, M.
        • Hanks G.
        • Thames Jr., H.
        • et al.
        Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: Recommendations of the RTOG-ASTRO Phoenix Consensus Conference.
        Int J Radiat Oncol Biol Phys. 2006; 65: 965-974
        • Kwok Y.
        • Yovino S.
        Update on radiation-based therapies for prostate cancer.
        Curr Opin Oncol. 2010; 22: 257-262
        • Al-Mamgani A.
        • van Putten W.L.
        • Heemsbergen W.D.
        • et al.
        Update of Dutch multicenter dose-escalation trial of radiotherapy for localized prostate cancer.
        Int J Radiat Oncol Biol Phys. 2008; 72: 980-988
        • Dearnaley D.P.
        • Sydes M.R.
        • Graham J.D.
        • et al.
        Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: First results from the MRC RT01 randomised controlled trial.
        Lancet Oncol. 2007; 8: 475-487
        • Kuban D.A.
        • Tucker S.L.
        • Dong L.
        • et al.
        Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer.
        Int J Radiat Oncol Biol Phys. 2008; 70: 67-74
        • Zietman A.L.
        • DeSilvio M.L.
        • Slater J.D.
        • et al.
        Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: A randomized controlled trial.
        JAMA. 2005; 294: 1233-1239
        • American Society for Therapeutic Radiology, Oncology Consensus Panel
        Consensus statement: Guidelines for PSA following radiation therapy.
        Int J Radiat Oncol Biol Phys. 1997; 37: 1035-1041


      Commenting Guidelines

      To submit a comment for a journal article, please use the space above and note the following:

      • We will review submitted comments as soon as possible, striving for within two business days.
      • This forum is intended for constructive dialogue. Comments that are commercial or promotional in nature, pertain to specific medical cases, are not relevant to the article for which they have been submitted, or are otherwise inappropriate will not be posted.
      • We require that commenters identify themselves with names and affiliations.
      • Comments must be in compliance with our Terms & Conditions.
      • Comments are not peer-reviewed.