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HDR Brachytherapy before or after RT?
Have there been any definitive studies done on which is better HDR Brachtherapy before or after RT? Two COE's I've consulted with do it the opposite, one does the Brachy procedure before and the other does it after RT. I do want to mention there is one difference, the center that does RT before does 23 sessions of IMRT then a few weeks later the Brachy. The other center does the Brachy first then a few weeks later 5 sessions of SBRT.
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There was a study done in Japan with brachytherapy Before RT and It had positive results. Unfortunately, I forgot to capture the link when I read the clinical trial information.
It is very common to do it here after the RT. It seems that works well too.
More aggressive cases of prostate cancer are treated that way frequently.
@jeffmarc Yes, both ways seem to work; it could be that IMRT is used over SBRT if there is a question of localized spread - EPE, proximal lymph node involvement…just a guess on my part.
Phil
1. It looks like there's no difference whether HDR Brachy is done first or last according to this 100-patient study:
https://www.redjournal.org/article/S0360-3016(23)08137-3/abstract
"The sequencing of HDR-BT and EBRT did not affect the incidence of G3 or G4 toxicities, and no significant differences were seen in other patient-reported outcomes."
2. Of course, I expect you'll want to compare SBRT and IMRT. Here's a 700-patient study:
https://www.renalandurologynews.com/news/sbrt-mh-imrt-prostate-cancer-better-quality-life-treatment-risk/
“What this trial really shows us is SBRT is not superior to IMRT, but it is safe and allows for excellent if not better quality of life outcomes. With the combination of the [NRG GU-005] trial and the PACE B trial showing [the radiation modalities were] noninferior, we can say that SBRT is a good option for our prostate cancer patients. It allows for convenience — 5 treatments vs 20-28 treatments – and good quality of life.”
3. Whichever RT treatments you choose, definitely consider a rectal spacer.
4. I'm guessing your doctors have already recommended that you begin Androgen Depravation Therapy (ADT). Generally, you'll choose between a daily pill (Orgovyx) or an injection that's good for 1-6 months, depending on which drug you're prescribed. Which drug(s) are best for you? How long should you continue ADT? This can all feel overwhelming; doctors can guide you with standard-of-care recommendations, but I bet you'll want to get well-informed so that you can make decisions that are best for YOU. And if possible, before you begin ADT, get a bone scan so that you can watch for early signs of osteopenia.
Best wishes.
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Hug
3 ReactionsThose considering EBRT of whatever stripe should get the ProsTOX test (MiraDx). It helps identify if either or both SBRT-IMRT forms may produce a lower or higher RISK of DELAYED urinary tract symptoms. They can occur months to years later. The immediate (ACUTE) symptoms are similar with the EBRTs and resolve in a similar time frame.
ORGAVYX (relugolix) an oral pill has recently been found to have less effect on the soft cardiac artery plaques attached to hard calcific plaque. The former is the culprit that breaks off and causes trouble downstream.
Since the particulars of your PCa were not detailed it is unclear whether LDR-BT would be an option too. It may not be available
at your institution and there is no obligation to suggest going elsewhere.
Consider looking up that subject at videos on You-Tube found on the PCRI, org. website. You might have to travel for it if applicable.
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Hug
1 ReactionWhen I was recently treated with 20 sessions of external beam plus HDR brachy boost at Fred Hutch in Seattle they did the HDR brachy first.
The Prostox test was not validated for HDR when I was considering my treatment options. The FAQ on the MiraKind website still says this.