MRI-Guided Ultrafocal HDR Brachytherapy for Localized Prostate Cancer: Median 4-Year Results of a feasibility study

Peters, Max; van Son, Marieke J.; Moerland, Marinus A.; Kerkmeijer, Linda G. W.; Eppinga, Wietse S. C.; Meijer, Richard P.; Lagendijk, Jan J. W.; Shah, Taimur T.; Ahmed, Hashim U.; van Zijp, Jochem R. N. van der Voort

doi:https://doi.org/10.1016/j.ijrobp.2019.03.032

MRI-Guided Ultrafocal HDR Brachytherapy for Localized Prostate Cancer: Median 4-Year Results of a feasibility study

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MRI-Guided Ultrafocal HDR Brachytherapy for Localized Prostate Cancer: Median 4-Year Results of a feasibility study

Peters, Max; van Son, Marieke J.; Moerland, Marinus A.; Kerkmeijer, Linda G. W.; Eppinga, Wietse S. C.; Meijer, Richard P.; Lagendijk, Jan J. W.; Shah, Taimur T.; Ahmed, Hashim U.; van Zijp, Jochem R. N. van der Voort

(2019) International Journal of Radiation Oncology Biology Physics, volume 104, issue 5, pp. 1045 - 1053

(Article)

Abstract

Purpose: For the treatment of localized prostate cancer, focal therapy has the potential to cure with fewer side effects than traditional whole-gland treatments. We report an update on toxicity, quality of life (QoL), and tumor control in our magnetic resonance imaging (MRI)-guided ultrafocal high-dose-rate brachytherapy cohort. Methods and Materials: Disease ... read more status was evaluated by systematic biopsies and 3T multiparametric MRI. The brachytherapy implant procedure under fused transrectal ultrasound/MRI guidance was followed by a 1.5 T MRI for contour adjustments and catheter position verification. A single dose of 19 Gy was delivered to the tumor with a margin of 5 mm. Genitourinary (GU) toxicity, gastrointestinal (GI) toxicity, and erectile dysfunction (ED) were graded with the Common Terminology Criteria for Adverse Events version 4.0. QoL was measured with RAND-36, European Organisation for Research and Treatment of Cancer QLQ-C30 and PR25. International Prostate Symptom Scores and International Index of Erectile Function scores were obtained. Prostate-specific antigen level was monitored, with biochemical recurrence defined as nadir + 2 ng/mL (Phoenix). Results: Thirty patients with National Comprehensive Cancer Network low- (13%) to intermediate-risk (87%) prostate cancer were treated between May 2013 and April 2016. Median follow-up was 4 years. Median age was 71 years (interquartile range, 68-73) and median initial prostate-specific antigen level was 7.3 ng/mL (5.2-8.1). Maximum Gleason score was 4 + 3 = 7 (in 2 patients). All tumors were radiologic (MRI) stage T2. No grade >2 GU or >1 GI toxicity occurred. International Prostate Symptom Scores only deteriorated temporarily. Mild pretreatment ED deteriorated to moderate/severe ED in 50% of patients. Long-term clinically relevant QoL deterioration was seen in sexual activity and tiredness, whereas emotional and cognitive functioning improved. At 4 years, biochemical disease–free survival was 70% (95% confidence interval, 52%-93%), metastases-free survival was 93% (85%-100%), and overall survival was 100%. Of intraprostatic recurrences, 7 of 9 were out of field. Conclusions: Ultrafocal high-dose-rate brachytherapy conveys minimal GU or GI toxicity and has a marginal effect on QoL. An early decline in erectile function was seen. Tumor control outcomes are poor (biochemical disease–free survival of 70% [52%-93%] at 4 years), most likely as a result of poor patient selection.

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Keywords: Aged, Brachytherapy/adverse effects, Disease-Free Survival, Feasibility Studies, Humans, Kallikreins/blood, Magnetic Resonance Imaging, Interventional/methods, Male, Prostate-Specific Antigen/blood, Prostatic Neoplasms/blood, Quality of Life, Radiotherapy Dosage, Radiotherapy, Image-Guided/adverse effects, Time Factors, Treatment Outcome, Journal Article, Research Support, Non-U.S. Gov't

DOI: https://doi.org/10.1016/j.ijrobp.2019.03.032

ISSN: 0360-3016

Publisher: Elsevier

Note: Funding Information: Disclosures: H.U.A. received funding from the Medical Research Council and Sonacare,Inc.H.U.A.‘s research is supported by core funding from the United Kingdom's National Institute for Health Research (NIHR) Imperial Biomedical Research Centre. H.U.A. currently receives funding from the Wellcome Trust, Prostate Cancer UK, Sonacare,Inc, Trod Medical, BTG International and Galil Medical, and Sophiris Biocorp for trials and studies in prostate cancer. H.U.A. is a paid medical consultant for Sophiris Biocorp and Sonacare, Inc. H.U.A. is a proctor for high-intensity focused ultrasound and cryotherapy and paid for training other surgeons in these procedures. M.P. declares a grant received in August 2017 from the Dutch Cancer Society for the phase 2 PRECISE study regarding focal salvage brachytherapy for radiorecurrent prostate cancer, outside the submitted work. T.T.S. would like to acknowledge funding from Prostate Cancer UK and the St Peters Trust for clinical research and has received funding in the past for conference attendance from Astellis, Ferring, and Galil Medical. J.R.N.V.Z. reports a grant from the Dutch Cancer Society for the phase 2 PRECISE study regarding focal salvage brachytherapy for radiorecurrent prostate cancer, outside the submitted work. L.G.W.K. reports grants from Elekta to UMC Utrecht, outside the submitted work; Elekta and Philips are members of the MR-linac Consortium. Elekta financially supports the MR-linac Consortium and member institutes. Disclosures: H.U.A. received funding from the Medical Research Council and Sonacare,Inc. H.U.A.‘s research is supported by core funding from the United Kingdom's National Institute for Health Research (NIHR) Imperial Biomedical Research Centre. H.U.A. currently receives funding from the Wellcome Trust, Prostate Cancer UK, Sonacare,Inc, Trod Medical, BTG International and Galil Medical, and Sophiris Biocorp for trials and studies in prostate cancer. H.U.A. is a paid medical consultant for Sophiris Biocorp and Sonacare, Inc. H.U.A. is a proctor for high-intensity focused ultrasound and cryotherapy and paid for training other surgeons in these procedures. M.P. declares a grant received in August 2017 from the Dutch Cancer Society for the phase 2 PRECISE study regarding focal salvage brachytherapy for radiorecurrent prostate cancer, outside the submitted work. T.T.S. would like to acknowledge funding from Prostate Cancer UK and the St Peters Trust for clinical research and has received funding in the past for conference attendance from Astellis, Ferring, and Galil Medical. J.R.N.V.Z. reports a grant from the Dutch Cancer Society for the phase 2 PRECISE study regarding focal salvage brachytherapy for radiorecurrent prostate cancer, outside the submitted work. L.G.W.K. reports grants from Elekta to UMC Utrecht, outside the submitted work; Elekta and Philips are members of the MR-linac Consortium. Elekta financially supports the MR-linac Consortium and member institutes. Publisher Copyright: © 2019 Elsevier Inc.

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