Background. Over the past few years, brachytherapy has become more and more common in the treatment of prostate
cancer. Part of the reason behind this growth in the use of brachytherapy for the treatment of organ-confined prostate
cancer is the reduced amount of acute and chronic side effects. On the other hand, brachytherapy allows for dose
escalation, resulting in significant improvements in the treatment results.
Method and Results. From August 2004 to June 2005, we irradiated 40 patients with T1c-T3a prostate cancer. All
of the patients underwent transperineal transrectal guided high dose rate (HDR) brachytherapy (two fractions, 8 Gy
per fraction) and course of external beam radiotherapy with a median dose of 45–50.4 Gy. The patients were classified
into three groups: low risk of recurrence (11 patients – 27.5 %), medium risk (14 patients – 35 %) and high risk
(15 patients – 37.5 %). The medium age of the patients was 68.7 years (range of between 55 and 77). Hormonal treatment
was carried out with 17 of the patients (42.5 %). We evaluated the quality of each implantation, including the
maximum urethral and rectal dose. The calculated doses were compared with measurements by in vivo dosimetry.
Acute toxicity was evaluated in all of the patients according to the Radiation Therapy Oncology Group (RTOG) scale.
Each of the patients completed an International Prostatic Symptom Score (IPSS) questionnaire. Acute genitourinary
morbidity grade 1 was recorded in 37.5 % of patients, and grade 2 in 15 % of patients. Urine retention in one of
the patients resulted in the need to perform an epicystostomy. According to the IPSS score, the majority of patients
(90 %) experienced an improvement in symptoms related to quality of life. Grade 1 acute gastrointestinal toxicity was
recorded in 40 % of the patients. Grades 2-4 were not recorded.
Conclusions. We showed that the combination of external beam radiotherapy and HDR brachytherapy in the treatment
of early prostate cancer to be feasible and well tolerated. Acute toxicity was low and scarcely influenced the
quality of life. Among the risk factors of genitourinary toxicity was the volume of the prostate. For gastrointestinal
toxicity, risk factors included a combination of HDR brachytherapy and external beam radiotherapy to the pelvis, as
well as hormonal treatment.
high dose rate brachytherapy, organ-confined prostate cancer, acute toxicity.