From a patient's perspective, who wouldn’t want a single-treatment prostate cancer regimen that worked as well as more involved alternatives? A clinical trial of high-dose-rate (HDR) brachytherapy has found that one dose can be a safe and effective solution.

The study was done at Oakland University’s William Beaumont School of Medicine, Royal Oak, Mich., and is available online in the International Journal of Radiation Oncology*Biology*Physics, the flagship journal of the American Society of Radiation Oncology.

“The single fraction regimen reported in this study simply represents further refinement of HDR treatment techniques that have been previously reported,” Dr. Daniel Krauss, lead author of the study, told HCB News.

“In my opinion, the technique reported here potentially represents an excellent option going forward. Namely, patients are treated in a single day in an outpatient procedure, largely resume normal activity levels within 24 hours, have no need for an indwelling urinary catheter, have no radiation exposure precautions to take after the procedure, and do not have to drive to daily radiation treatments for 1-2 months’ duration,” he added.

The only surprise in the study, according to Krauss, was just how low the toxicity was for the patients. While the researchers expected the treatment to be tolerated well by patients, Krauss anticipated the urinary toxicity would be slightly greater.

“Everyone, myself included, emphasized the fact that single fraction HDR brachytherapy should not yet be offered outside the context of a clinical trial until longer follow up demonstrates at least comparable disease control relative to multi-fraction HDR treatment regimens,” Krauss said.

Should single fraction HDR brachytherapy prove as effective as multi-fraction regimens with additional follow up and study, it will reduce the degree of invasiveness of the treatment overall, improve workflow efficiency and, potentially, greatly reduce the cost of definitive prostate cancer management.

For patients with advanced or aggressive prostate cancer, HDR brachytherapy, when used, is generally combined with a one-month course of external beam treatment and hormonal therapy, Krauss said.

“It is my hope that there will be a greater understanding and acceptance of the value of HDR brachytherapy in the management of localized prostate cancer patients,” Krauss said. “While there has never been proof of superiority of one local prostate cancer therapy over another (i.e. external beam radiotherapy vs. brachytherapy vs. surgery), it is up to doctors and other involved health care professionals to ensure that all treatment options are presented to patients so that they can make the most informed decision possible regarding their management.”

For such patients, survival rates would likely be extremely high regardless of the local therapy chosen — whether it is brachytherapy, external beam radiotherapy, or surgery.

“Because of this, patients frequently face a difficult decision as treatment comes down to a choice between multiple highly effective options. It is incumbent upon physicians to provide a fair and balanced discussion of those options so patients are able to make the most informed, and thereby comfortable, decision that they possibly can,” he said.

Side effect profiles differ among treatment options, but so do follow-up implications and logistics of the treatments themselves.

“It is my feeling that HDR brachytherapy compares very favorably to both external beam treatment as well as surgery in terms of cancer control rates and rates of treatment-related complications,” Krauss explained.

Having demonstrated the safety of single fraction brachytherapy treatment in this report, the next step is to determine the optimal single fraction HDR dosing regimen, he said. The current protocol open at William Beaumont Hospital is evaluating the same treatment with an approximately 10 percent increase in the prescription dose.

Given the low toxicity rates seen in the published report, Krauss and his colleagues are confident that this level of dose escalation will be well-tolerated and potentially result in improved disease control rates with long-term follow-up.

HDR brachytherapy is used to treat a wide range of cancers: most notably prostate, breast, and gynecologic malignancies, he said. It is used less commonly as adjuvant therapy for sarcomas and head and neck cancers and occasionally as a palliative treatment in gastrointestinal and lung cancer.