Treating prostate cancer with a single, high dose of radiation delivered precisely to the site of the tumour results in good quality of life and fewer trips to the hospital, with adverse side effects that are no worse than if the radiation treatment had been given in several lower doses, according to a recent study. Alfonso Gomez-Iturriaga, from the Hospital de Cruces, Baracaldo, Spain, told the ESTRO 36 conference that the results were encouraging from the phase II trial of high-dose rate (HDR) brachytherapy, delivered in a single fraction of 19Gy, to 45 patients with prostate cancer that was at low or intermediate risk of spreading elsewhere in the body.
Gomez-Iturriaga noted that the 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. 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.
He added, “It is too early to say that this strategy can be used outside the trial setting, but it seems quite clear that the toxicity and impact on quality of live are very low. Longer follow-up for at least five years is needed to demonstrate definite cancer control.”
HDR brachytherapy involves the very precise positioning of catheters, with the aid of ultrasound, at the site of the tumour while the patient is under spinal or general anaesthetic. A radioactive source (iridium-192) is delivered via the catheters to the target, avoiding other structures such as the bladder and the bowel, so that they deliver the maximum dose precisely to the target. The treatment usually takes about 30 minutes.
Though HDR brachytherapy has been considered for treating prostate cancer, until now there has been limited evidence of its safety and efficacy. In this study, 45 consecutive patients received HDR brachytherapy at the Hospital de Cruces between January 2014 and July 2016.
In terms of quality of life, the need to pass urine urgently declined significantly between the first and sixth month after treatment and had returned to normal after a year. There were no significant changes in bowel movements, sexual or hormonal functioning. Sixty percent of patients who had normal sexual functioning before the treatment continued to function normally afterwards. Six months after the radiation therapy, 77 percent of patients said they were “extremely satisfied” with their treatment and quality of life and 23 percent were “very satisfied.”
Gomez-Iturriaga said that these were excellent results in terms of patient satisfaction, quality of life, toxicity and tolerability and safety.