HDR Brachytherapy in Prostate Cancer: Pros and Cons

The use of high-dose-rate (HDR) brachytherapy as a salvage local therapy following primary radiation in prostate cancer yields solid biochemical control, but at the cost significant grade 3 genitourinary morbidities, according to a study presented at the 2022 American Society for Radiation Oncology Annual Meeting.

In this study, presenting author Maxence Cloutier, MD, and colleagues assessed 60 patients with biopsy-proven local prostate cancer. The primary outcomes of interest were early and late genitourinary (GU) and gastrointestinal (GI) toxicities. Biochemical disease-free survival served as the secondary end point.

Following analysis, GI toxicities were deemed acceptable, with 3.6% and 14.5% of patients experiencing early and late grade 2 toxicities, respectively. No grade 3 GI toxicities were reported. While early grade 2 GU toxicities were 100%, that percentage may have been skewed by all patients using an alpha-blocker in the postoperative setting. Notably, the findings showed that late GU toxicities were significant, with 14.5% of patients experiencing late grade 3 toxicity.

“Salvage HDR brachytherapy after primary radiation to the prostate offers good biochemical control but at the cost of significant [grade] 3 GU morbidities,” the researchers concluded. “Patients can benefit from local therapy after primary radiation, but whole-gland radiation should be used with caution because of concern with toxicities. Focal therapy to partial gland might be a good alternative to achieve local control and avoid severe toxicities.”

Source: Cloutier M, Carignan D, Lavallee MC, et al. A pilot study of salvage HDR brachytherapy in recurrent prostate cancer: 5 year toxicity and outcomes. Abstract 2484. Presented at the 2022 ASTRO Annual Meeting; October 23-26, 2022; San Antonio, TX.