Top Line: Do patients report better quality of life after HDR or LDR brachytherapy boost for prostate cancer?
The Study: Both LDR and HDR brachytherapy are used to deliver a boost to the prostate after (or sometimes before) pelvic external beam radiation for intermediate and high risk prostate cancer. In this single institution randomized trial, 195 patients with unfavorable intermediate risk (43%) or high risk (57%) prostate cancer were randomized to receive pelvic external beam radiation (46 Gy in 23 fractions) with either an HDR (15 Gy in 1 fraction) or LDR (110 Gy using I-125) boost. An important difference between arms was that the HDR boost was delivered prior to EBRT while the LDR boost was delivered after. Most (75%) received ADT. A higher proportion of patients randomized to HDR were treated with IMRT or VMAT (74% v 61%). Baseline EPIG GU and GI domain scores were similar between arms. GU QOL scores decreased in both groups initially after treatment with faster recovery in the HDR arm. GU QOL in the LDR arm took longer to recover, but by 18 months there was no difference between arms. GI QOL decreased after treatment with both arms and nadired around 12 months. While GI QOL improved back to baseline in the HDR arm, patients in the LDR arm reported GI QOL that was worse than baseline long-term.
TBL: This randomized trial found that patients treated with HDR boost prior to EBRT for prostate cancer report faster improvement in GU QOL and better GI QOL than those treated with an LDR boost after EBRT. | Crook, Int J Radiat Oncol Biol Phys 2024
The Study: Both LDR and HDR brachytherapy are used to deliver a boost to the prostate after (or sometimes before) pelvic external beam radiation for intermediate and high risk prostate cancer. In this single institution randomized trial, 195 patients with unfavorable intermediate risk (43%) or high risk (57%) prostate cancer were randomized to receive pelvic external beam radiation (46 Gy in 23 fractions) with either an HDR (15 Gy in 1 fraction) or LDR (110 Gy using I-125) boost. An important difference between arms was that the HDR boost was delivered prior to EBRT while the LDR boost was delivered after. Most (75%) received ADT. A higher proportion of patients randomized to HDR were treated with IMRT or VMAT (74% v 61%). Baseline EPIG GU and GI domain scores were similar between arms. GU QOL scores decreased in both groups initially after treatment with faster recovery in the HDR arm. GU QOL in the LDR arm took longer to recover, but by 18 months there was no difference between arms. GI QOL decreased after treatment with both arms and nadired around 12 months. While GI QOL improved back to baseline in the HDR arm, patients in the LDR arm reported GI QOL that was worse than baseline long-term.
TBL: This randomized trial found that patients treated with HDR boost prior to EBRT for prostate cancer report faster improvement in GU QOL and better GI QOL than those treated with an LDR boost after EBRT. | Crook, Int J Radiat Oncol Biol Phys 2024