Date Published: February 22, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Susan Masson, Raj Persad, Amit Bahl.
High-dose-rate (HDR) brachytherapy is used with increasing frequency for the treatment of prostate cancer. It is a technique which allows delivery of large individual fractions to the prostate without exposing adjacent normal tissues to unacceptable toxicity. This approach is particularly favourable in prostate cancer where tumours are highly sensitive to dose escalation and to increases in radiotherapy fraction size, due to the unique radiobiological behaviour of prostate cancers in contrast with other malignancies. In this paper we discuss the rationale and the increasing body of clinical evidence for the use of this technique in patients with high-risk prostate cancer, where it is combined with external beam radiotherapy. We highlight practical aspects of delivering treatment and discuss toxicity and limitations, with particular reference to current practice in the United Kingdom.
There is an ever-increasing demand for radiation techniques in the management of high-risk localised and locally advanced prostate cancer which allow dose escalation, whilst minimising the risks of acute and late severe toxicity. High-dose-rate (HDR) brachytherapy is ideally suited to achieving these goals for several reasons.
Prostate cancer is the commonest malignancy in men, and in the UK approximately 40,000 cases are diagnosed annually . Incidence is increasing, partly due to the increasing use of the serum PSA assay in symptomatic and asymptomatic patients. There are many patients with prostate cancer who will not die from their disease, even without treatment in some cases. However, patients with more aggressive forms of the disease require an intensive approach to treatment to maintain a normal life expectancy.
Favourable long-term local control rates and overall survival are seen when high-risk patients are treated with primary radiotherapy in combination with the addition of androgen suppression, prior to and after radiotherapy [6–9]. This approach has therefore become a standard of care for patients with high-risk disease. The duration of long-term adjuvant androgen suppression after radiotherapy varies in published studies, but improvements in progression-free survival have been demonstrated where 2 or 3 years of androgen suppression are used, compared with durations of 6 months or less [8, 9].