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Radiother Oncol. 2016 Apr;119(1):91-6. doi: 10.1016/j.radonc.2016.02.004. Epub 2016 Feb 15.

Dose escalation to dominant intraprostatic lesions with MRI-transrectal ultrasound fusion High-Dose-Rate prostate brachytherapy. Prospective phase II trial.

Author information

1
Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain. Electronic address: agomeziturriaga@gmail.com.
2
Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain.
3
Hospital Universitario Cruces, Radiology, Barakaldo, Spain.
4
Hospital Universitario Cruces/Biocruces Health Research Institute, Barakaldo, Spain.
5
Hospital Universitario Cruces, Physics, Barakaldo, Spain.
6
Hospital Universitario Cruces, Urology, Barakaldo, Spain.
7
Hospital Universitario Cruces/Biocruces Health Research Institute, Clinical Epidemiology Unit, Barakaldo, Spain.
8
Cancer Center for the Southern Interior, Radiation Oncology, British Columbia Cancer Agency, Kelowna, Canada.

Abstract

BACKGROUND AND PURPOSE:

To demonstrate the feasibility, safety and effectiveness of dose escalation to intraprostatic lesions with MRI-transrectal ultrasound fusion High-Dose-Rate (HDR) brachytherapy.

MATERIALS AND METHODS:

15 patients with intermediate-high risk prostate cancer and visible dominant intra-prostatic nodule on mpMRI have been treated. The treatment consisted of combined MRI-TRUS fusion HDR-brachytherapy (1 fraction of 1500cGy) and hypofractionated external beam (3750cGy in 15 fractions). A dose of 1875Gy was delivered to at least 98% of the DIL volume.

RESULTS:

Median prostate volume was 23.8cc; median number of needles was 16 (13-18). Dose escalation to DIL was feasible in 14/15 patients (93%) without violating dosimetric constraints and 1 patient presented a minimal deviation of dosimetric restrictions. With a median follow-up of 18months (17-24), none of the patients developed acute urinary retention or grade ⩾3 toxicity. In addition to standard PSA follow-up, response has been assessed by mpMRI at 12months. All patients presented adequate morphological responses on anatomical and functional sequences.

CONCLUSIONS:

HDR brachytherapy using MRI-transrectal ultrasound fusion for image guidance is a suitable technique for partial prostate dose escalation. Tolerance and toxicity profiles are excellent and results are encouraging in terms of biochemical, morphological and functional response.

KEYWORDS:

Dominant intraprostatic lesion; Dose escalation; High-Dose-Rate brachytherapy; Prostate cancer

PMID:
26900090
DOI:
10.1016/j.radonc.2016.02.004
[Indexed for MEDLINE]

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