Feature | April 29, 2015

Brachytherapy Implants Reduce Five-Year Risk of Prostate Cancer Recurrence

ASCENDE-RT trial compares effectiveness of brachytherapy with dose-escalated external beam radiotherapy

brachytherapy, ESTRO, radiotherapy, five-year recurrence, ASCENDE-RT

April 28, 2015 — Results from a randomized controlled trial comparing permanent radioactive implants (brachytherapy) with dose-escalated external beam radiotherapy in patients with prostate cancer showed brachytherapy patients were twice as likely to be cancer-free five years later.

Presenting these results at the 3rd European Society for Radiotherapy and Oncology (ESTRO) Forum in Barcelona, Spain, was Prof. James Morris, from the Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency (BCCA), Vancouver, Canada. Morris said that the ASCENDE-RT trial is the first and only existing trial comparing low-dose-rate prostate brachytherapy (LDR-PB) for the curative treatment of prostate cancer with any other method of radiation therapy delivery.

The trial enrolled 398 men with cancer that had not spread outside the prostate gland who were judged to be at high risk of treatment failure, based on standard tests for a number of features of the cancer. The patients initially received androgen deprivation therapy (ADT), aimed at reducing levels of the male hormones that stimulate prostate cancer cells to grow. After eight months of ADT, all patients received 46 Gy2 of external beam radiotherapy to the prostate and regional lymph nodes.

Following this, 198 men received LDR-PB in which tiny radioactive seeds were implanted in the prostate gland while under general or spinal anesthesia. The other 200 patients were randomized to dose-escalated external beam radiation therapy (DE-EBRT) and received an additional 32 Gy of external beam radiation to achieve a total prostate dose of 78 Gy.

"At five years follow-up, we saw a large advantage in progression-free survival in the LDR-PB group," Morris said. "Although, to date, overall survival and prostate cancer-specific survival do not appear to differ between the two groups, existing trends favor LDR-PB and an overall survival advantage is likely to emerge with longer follow-up."

LDR-PB is an extremely cost-effective treatment, the researchers said, but it does require prolonged training and experience in order to produce consistent results, and this may limit more widespread adoption. An additional problem is that, in the trial, the LDR-PB patients experienced more urinary side effects that those who received DE-EBRT. In a separate presentation Morris's clinical research fellow, Sree Rodda, told the conference that the incidence of severe late urinary side effects was three times higher in patients who received LDR-PB than in those who had DE-EBRT. "Many of these severe adverse effects were temporary and reversible, or could be ameliorated by procedures. Moreover, more than 80 percent of patients in the LDR-PB arm had few or no long term urinary side effects." However, she said, "the long-term prevalence of severe urinary toxicity in the LDR-PB patients was 8 percent compared to just 2 percent for the DE-EBRT patients. An important challenge for the future will be the reduction of these adverse effects while maintaining the advantages of LDR-PB."

At BCCA's five cancer centers, LDR-PB boost is now regarded as the standard of care for unfavorable-risk localized prostate cancer. "The ideal next step," Morris said, "would be to undertake randomized comparisons of LDR-PB boost against its principal alternatives — temporary high-dose-rate brachytherapy implants (HDR-PB), stereotactic body radiation therapy using extreme hypofractionation, and combined surgery and post-operative radiation therapy.

"In the meantime, ASCENDE-RT has made an important contribution to the search for a more effective curative treatment for prostate cancer," he concluded.

Prof. Philip Poortmans, president of ESTRO, commented: "This study illustrates very nicely how the best results can be obtained by combining various treatment options instead of trying to get the most out of one single modality. Brachytherapy is an extremely efficient and safe radiation oncology modality, and this trial shows that it can have a wider field of applicability than simply in very localized and low-risk tumors when combined with other techniques - in this case, androgen deprivation therapy and external bean radiation therapy."

For more information: www.estro.org

Related Content

Proton Therapy Lowers Risk of Side Effects Compared to Conventional Radiation
News | Proton Therapy | May 23, 2019
Cancer patients getting proton therapy instead of traditional photon radiation are at a significantly lower risk of...
VolparaDensity With Tyrer-Cuzick Model Improves Breast Cancer Risk Stratification
News | Breast Density | May 22, 2019
Research has demonstrated use of Volpara Solutions' VolparaDensity software in combination with the Tyrer-Cuzick Breast...
Henry Ford Hospital's ViewRay MRIdian linear accelerator system allows real-time MRI-guided radiotherapy. Shown is the support staff for this system. In the center of the photo is Benjamin Movsas, M.D., chair of radiation oncology at Henry Ford Cancer Institute. Second from the right is Carrie Glide-Hurst, Ph.D., director of translational research, radiation oncology.

Henry Ford Hospital's ViewRay MRIdian linear accelerator system allows real-time MRI-guided radiotherapy. Shown is the support staff for this system. In the center of the photo is Benjamin Movsas, M.D., chair of radiation oncology at Henry Ford Cancer Institute. Second from the right is Carri Glide-Hurst, Ph.D., director of translational research, radiation oncology.

Feature | Henry Ford Hospital | May 21, 2019 | Dave Fornell, Editor
Henry Ford Hospital thought leaders regularly speak at the radiation oncology and radiology conferences about new res
Varian Acquiring Cancer Treatment Services International
News | Radiation Therapy | May 21, 2019
Varian Medical Systems announced it has entered into a definitive agreement to acquire India’s Cancer Treatment...
Videos | Radiation Therapy | May 21, 2019
This is a walk through of the ViewRay MRIdian MRI-guided radiotherapy system installed at ...
Partial Breast Irradiation Effective, Convenient Treatment Option for Low-Risk Breast Cancer
News | Radiation Therapy | May 20, 2019
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast...
AI Detects Unsuspected Lung Cancer in Radiology Reports, Augments Clinical Follow-up
News | Artificial Intelligence | May 20, 2019
Digital Reasoning announced results from its automated radiology report analytics research. In a series of experiments...
New Study Evaluates Head CT Examinations and Patient Complexity
News | Neuro Imaging | May 17, 2019
Computed tomography (CT) of the head uses special X-ray equipment to help assess head injuries, dizziness and other...
New Phase 2B Trial Exploring Target-Specific Myocardial Ischemia Imaging Agent
News | Radiopharmaceuticals and Tracers | May 17, 2019
Biopharmaceutical company CellPoint plans to begin patient recruitment for its Phase 2b cardiovascular imaging study in...