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Is once ever enough? (for HDR brachytherapy, that is)

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Prostate Cancer
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Posted 1/18/2017 8:13 AM (GMT 0)
Some ROs are trying to do a complete course of HDR brachytherapy with a single fraction of 19 Gy. It's undoubtedly less costly and much more convenient for the patient (easier on the RO and his staff too). But preservation of sexual function may not be quite as good, and it's much too early to tell if oncological control is as good. There are a few radiobiological reasons why it might not be.

/pcnrv.blogspot.com/2017/01/is-once-ever-enough.html
Posted 1/18/2017 12:34 PM (GMT 0)
With good results demonstrated for other HDR protocols, it doesn't seem prudent to me to chance this not yet established route for it's convenience.

Though those who are paying out of pocket may have a reason to consider it for the lower cost. Or maybe for those who are deciding to treat an older age when sexual function and long term prospects are factored differently than for younger guys.
Posted 1/18/2017 12:36 PM (GMT 0)
We know there is effectiveness for mono therapy using traditional fraction dose by Demanes through the reports he has made. Of course this is for the lower risk presentations according to his requirements.

Your question applies to the more intermediate and higher risk presentations like myself. How would I be doing if I had one higher dose fraction instead of two standard dose fractions?
Posted 1/18/2017 6:16 PM (GMT 0)
JNF-

You're right that this only applies to monotherapy. With the kind of combined therapy that you had, several ROs (including Martinez) do the HDRBT part in a single fraction. Because you received fractionation from the external beam part of your therapy, the arguments for fractionation don't apply.

They did a RCT among intermediate risk guys at Sunnybrook comparing a single boost dose to a split boost dose. The outcomes were no different:

Is single fraction 15 Gy the preferred high dose-rate brachytherapy boost dose for prostate cancer?
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