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  • br P value calculated using Kruskal Wallis test

    2019-11-04


    * P value calculated using Kruskal-Wallis test.
    y P value calculated using Student t test.
    groups at any measured time point. Time to IPSS reso-lution was significantly shorter in the HDRB group (median, 2 months) compared with the LDRB group (median, 6 months; P Z .028; Fig 2). As for the
    Table 2 Treatment characteristics for LDRB
    Characteristics Median (range)
    Abbreviations: CT Z computed tomography; LDRB Z low-dose-rate brachytherapy.
    * D90: Radiation dose delivered to 90% of the prostate volume. y
    scription dose. 
    physician-reported grade 2 toxicities using CTCAE version 4, no significant difference was found between the 2 treatment arms in regard to urinary, bowel, and sexual toxicities. The grade 2 urinary toxicity rates of LDRB and HDRB at different time points are detailed in Table 4. No grade 3 toxicity was reported.
    Discussion
    Increasing evidence supports the use of HDRB as monotherapy in localized prostate cancer. Indeed, HDRB offers many advantages over LDRB: It allows optimiza-tion of both source dwell times and positions, providing better target coverage while sparing the normal tissue, and limits Relebactam exposure for the patient and the staff.10
    Table 3 Treatment characteristics for HDRB
    Characteristics Median (range)
    Abbreviation: hDRB Z high-dose-rate brachytherapy
    Figure 1 Health-related quality of life differences between low dose-rate brachytherapy and high-dose rate brachytherapy.
    HDRB is generally considered to have less acute and late urinary toxicity compared to LDRB.9,14,21 Indeed, the
    results of our study revealed improved HRQOL scores with HDBR in the acute and long-term setting compared with LDRB.
    A total of 31 patients were enrolled and treated with either LDRB or single-fraction 19-Gy HDRB. No dif-ferences in patients’ characteristics were reported in the 2 arms. The prostate volume at the time of brachytherapy 
    was significantly higher in the HDRB group (median, 54.3 vs 40.7 mL; P Z .016), which could be explained by the heterogeneity in the brachytherapy imaging modality used considering prostate volume is better defined on TRUS.42 TRUS-based treatment planning was exclu-sively used in all LDRB cases, whereas both TRUS- and CT-based treatment planning was used for HDRB as per institutional standard. In HDRB cases, TRUS-based treatment planning was used in 8 patients, and CT-
    Figure 2 Time to International Prostate Symptom Score resolution illustrated using Kaplan-Meier estimator curves.
    Advances in Radiation Oncology: --- 2019 HDR vs LDR brachytherapy for prostate cancer 7
    Table 4 CTCAE version 4 urinary toxicity rates atdifferent time points
    Dysuria
    frequency
    obstruction
    Abbreviations: CTCAE Z Common Terminology Criteria for Adverse Events; HDRB Z high-dose rate brachytherapy; LDRB Z low dose-rate brachytherapy.
    based treatment planning was used in the remaining 8 patients as per institutional standard. In HDRB, prostate volume is not a limiting factor as long as the dosimetric constraints are achieved.43 The number of needles used for LDRB was higher than in HDRB, which is inherent to the LDRB technique.
    HDRB was associated with improved EPIC urinary irritative and IPSS scores at 3 months (P Z .037 and P Z .003, respectively) and on repeated measures at 1, 3, 6, and 12 months (P Z .019 and P Z .003, respec-tively). There were no significant differences in the EPIC urinary incontinence, sexual function, or bowel habits scores between the 2 groups at any measured time point. Time to IPSS resolution was significantly shorter in the HDRB group (mean, 2.0 months) compared with the LDRB group (mean, 6.0 months; P Z .028). Acute urinary toxicity is not trivial; presence of acute urinary toxicity in patients treated with LDRB has been corre-lated with late urinary toxicity44 and was associated with decreased QoL, leading to increased psychologic distress.45 Acute urinary retention after prostate brachytherapy can lead to several side effects, such as prolonged catheterization, urethral and suprapubic pain, bleeding, loss of dignity, loss of job or absence from school, lack of sexual intercourse, pericatheter leakage of urine, and recurrent urinary tract infection.46 The management of urinary obstruction ranges from a-blockade to prolonged catheterization and surgical intervention, including transurethral resection of the prostate, the latter resulting in diminished QoL.47,48 The psychologic and emotional burden of acute urinary retention and catheterization significantly influenced health-related QoL.49