HDR Brachytherapy Vs High Dos IMRT

There is an interesting study of HDR brachytherapy + IMRT versus high dosage IMRT on the Infolink forum.

http://prostatecancerinfolink.net/2010/08/23/outcomes-of-hdr-brachytherapy-imrt-vs-very-high-dose-imrt-alone/

“The authors conclude that dose escalation carried out by adding IMRT to HDR brachytherapy provided improved bPFS in the treatment of prostate cancer compared with very high-dose IMRT, independent of risk group on multivariate analysis. The most significant benefit appeared to be available for intermediate-risk patients.”

All of us want to believe, indeed even need to believe, that the treatment we chose was the best one for the circumstances. I am to this point very satisfied with my choice, which was LDR brachytherapy + IMRT + HT. However, in retrospect HDR brachytherapy + IMRT appears to be a very promising treatment option for any risk group of PCa and if I were able to revisit my own decision it might be different.

Sancarlos

I just finished talking at length about this with my R-doc and he was of the opinion (through years of experience and careful study) that while combined Brachytherapy and IGRT can indeed produce high cure rates, (but not significantly higher than IGRT alone, all things being equal), the acute side-effect risk climbs to unacceptable levels.

Many times, these side effects manifest themselves years later as the injured urethra, bladder and rectal tissue require major surgery to repair and often result in double stoma's..

He freely admitted that there are probably a few specialists at advanced clinics and treatment centers who have perfected this treatment and minimized the side-effects.. He may be over-stating the risks, as I had a good friend 75 years old, who had seeds-IGRT combo done in El Paso, TX, not exactly an MD Anderson setting...He had only minor side effect issues and died of of sudden heart attack six years later at age 82.

The concept of radiation is fairly simple: The higher the dose and the more accurrately it is delivered will result in greater effectiveness and less side affects. The issue is how to deliver the dose. It doesn't matter if it's proton, photon, fractionated, seeds or X ray, the output energy is the same, measured in greys. More greys mean more killing power, but also more side affects to adjcent organs.
The older ERBT was about 61 gy and resulted in a lot of reoccurrances. It was found that at least 81gy needed to be given. Cyberknife, HDR Brachy, IGRT are all different ways of delivering the energy dose. Any improvements in accurracy of getting the dose to go exactly where it is intended is always better.
The reason that Brachy/IMRT combination is used is that a dose of up to 150gy can be safely given. An IMRT or Proton dose that high would fry all the surrounding area.
It's all about acccurracy and energy dose, the more accurrate, the higher the dose that can be safely given, and the higher the dose the better killing power.
JT