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A Pooled Analysis of Biochemical Failure in Intermediate-risk Prostate Cancer Following Definitive Stereotactic Body Radiotherapy (SBRT) or High-Dose-Rate Brachytherapy (HDR-B) Monotherapy

Hegde, John, V., MD*; Collins, Sean, P., MD; Fuller, Donald, B., MD; King, Christopher, R., PhD, MD*; Demanes, D., Jeffrey, MD*; Wang, Pin-Chieh, PhD*; Kupelian, Patrick, A., MD*; Steinberg, Michael, L., MD*; Kamrava, Mitchell, MD*

American Journal of Clinical Oncology: May 2018 - Volume 41 - Issue 5 - p 502–507
doi: 10.1097/COC.0000000000000311
Original Articles: Genitourinary

Objectives: To investigate biochemical relapse-free survival (BRFS) in men with National Comprehensive Cancer Network-defined intermediate-risk prostate cancer (PC) treated with either stereotactic body radiotherapy (SBRT) or high-dose-rate brachytherapy (HDR-B) monotherapy.

Materials and Methods: A retrospective, multi-institutional analysis of 437 patients with intermediate-risk PC treated with SBRT (N=300) or HDR-B (N=137) was performed. Men who underwent SBRT were treated to 35 to 40 Gy in 4 to 5 fractions. A total of 95.6% who underwent HDR-B were treated to 42 Gy in 6 fractions. Baseline patient characteristics were compared using a T test for continuous variables and the Mantel-Haenszel χ2 metric or Fisher exact test for categorical variables. Kaplan-Meier curves were generated to estimate 5-year actuarial BRFS. Multivariate analysis using a Cox proportional-hazards model was used to evaluate factors associated with biochemical failure.

Results: The mean age at diagnosis was 68.4 (SD±7.8) years. T-category was T1 in 63.6% and T2 in 36.4%. Mean initial prostate-specific antigen was 7.4 (SD±3.4) ng/mL. Biopsy Gleason score was ≤3+4 in 82.8% and 4+3 in 17.2%. At a median of 4.1 years of follow-up, the BRFS rate (Phoenix definition) was 96.3%, with no difference when stratifying by treatment modality or biologically equivalent dose (BED1.5). On multivariate analysis, age (hazard ratio 1.08, P=0.04) and biopsy Gleason score (hazard ratio 2.48, P=0.03) were significant predictors of BRFS.

Conclusions: With a median follow-up period of 4 years, SBRT and HDR-B monotherapy provide excellent BRFS in intermediate-risk PC. Longer-term follow-up is necessary to determine the ultimate efficacy of these hypofractionated approaches, but they appear promising relative to standard fractionation outcomes.

*Department of Radiation Oncology, UCLA Medical Center, Los Angeles

Division of Genesis Healthcare Partners Inc., CyberKnife Centers of San Diego Inc., San Diego, CA

Department of Radiation Medicine, Georgetown University Medical Center, Washington, DC

S.P.C. serves as a paid SBRT clinical consultant to Accuray Inc. D.B.F. has stock ownership in Accuray Inc. and Varian. P.A.K.’s institution receives grant money and fees for participation in review activities from Accuray Inc. He also serves as a paid consultant for Varian and ViewRay. Furthermore, his institution has received payment from Varian and BrainLab for lectures and from Varian for expert testimony and grants. The other authors declare no conflicts of interest.

Reprints: Mitchell Kamrava, MD, 200 UCLA Medical Plaza, Suite B265, Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA 90095. E-mail:

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