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  • br Sources of support This work was supported

    2019-11-04


    Sources of support: This work was supported by AbbVie- CARO Uro-Oncologic Radiation Awards 2015, Canada. The funding source had no role in study design, data collection, data interpretation, data analysis, or writing of this report.
    Disclosures: The authors have no conflicts of interest to disclose.
    * Corresponding author. Department of Radiation Oncology, Rutgers Cancer, Institute of New Jersey, Rutgers, The State University of New Jersey,
    2452-1094/ 2019 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
    Results: LDRB and HDRB were performed in 15 and 16 patients, respectively, for a total of 31 patients. At 3 months, patients treated with LDRB had a higher IPSS score (mean, 15.5 vs 6.0, respectively; P Z .003) and lower EPIC urinary irritative score (mean, 69.2 vs 85.3, respectively; P Z .037) compared with those who received HDRB. On repeated measures at 1, 3, 6, and 12 months, the IPSS (P Z .003) and EPIC urinary irritative scores (P Z .019) were significantly better in the HDR arm, translating into a lower urinary toxicity profile. There were no significant differences in the EPIC urinary incontinence, sexual, or bowel habit scores between the 2 groups at any measured time point. Time to IPSS Cefepime was significantly shorter in the HDRB group (mean, 2.0 months) compared with the LDRB group (mean, 6.0 months; P Z .028).
    Conclusions: HDRB monotherapy is a promising modality associated with a lower urinary toxicity profile and higher HRQOL in the first 12 months compared with LDRB.
    2019 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
    Introduction
    Low-dose-rate brachytherapy (LDRB) using a per-manent seed implant is an effective definitive treatment for patients with localized low-risk and favorable intermediate-risk prostate cancer1-6 with a prostate-
    of the NRG Oncology/Radiation Therapy Oncology Group 0232 study were presented at the American So-ciety for Radiation Oncology in 2016; the addition of external beam radiation therapy (EBRT) to LDRB did not result in improved PFS in a phase 3 randomized trial,8 suggesting that LDRB as monotherapy is an effective treatment in low-risk and favorable intermediate-risk prostate cancer.
    High-dose-rate brachytherapy (HDRB) as a single modality is emerging as an alternative to LDRB with excellent outcomes as reported by retrospective and phase 2 studies.9-12 Common problems associated with perma-nent seeds implant include discrepancy between planned and actual seed distribution, inability to correct seed po-sition or to optimize the dose delivered once the seeds are in place,10 seed migration,13 and prostate volume changes during treatment, all of which are not relevant in HDRB. The main disadvantages of HDRB are monitoring and adjustment of catheters, inter- and intrafraction motion, and requirement for catheter and template fixation and locoregional anesthesia (spinal or epidural) if computed tomography (CT)-based planning is performed.10 Because a single radioactive source is used for many treatments, HDRB can be deployed in a cost-effective manner.10
    Many studies have shown the feasibility and efficacy of HDRB as monotherapy in patients with intermediate risk-prostate cancer with 3- to 5-year PSA PFS as high as
    88% to 100% for intermediate-risk prostate cancer at a median follow-up of 3 to 5 years.9-11,14-16 Most of the