Low Dose Rate Brachytherapy versus Cryotherapy in Low and Intermediate Risk Prostate Cancer

Publication date: Available online 16 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Matthew M. Gestaut, Wendi Cai, Shilpa Vyas, Belur J. Patel, Salman A. Hasan, Yolanda MunozMaldonado, Niloyjyoti Deb, Gregory Swanson
PurposeCryotherapy and brachytherapy are definitive local treatment options for low- to intermediate-risk prostate cancer. There are both prospective and retrospective data for brachytherapy, but the use of cryotherapy has been limited primarily to single institutional retrospective studies. Currently, no published evidence has compared low-dose rate brachytherapy versus cryotherapy.MaterialsInstitutional Review Board approval was obtained to conduct a retrospective chart review of consecutive patients treated at our institution from 1990-2012. For inclusion, patients must have carried prostate cancer diagnoses and have been considered low- to intermediate-risk according to the National Comprehensive Cancer Network criterion. All patients received brachytherapy or cryotherapy treatment. Disease specifics and failure details were collected for all patients. Failure was defined as prostate-specific antigen nadir +2ng/mL.ResultsA total of 359 patients were analyzed. Groups were comprised of 50 low-risk cryotherapy (LRC), 92 intermediate-risk cryotherapy (IRC), 133 low-risk brachytherapy (LRB), and 84 intermediate-risk brachytherapy (IRB) patients. Median prostate-specific antigen follow-up was 85.6 months (LRC), 59.2 months (IRC), 74.9 months (LRB), and 59.8 months (IRB). The 5-year biochemical progression free survival (bPFS) between the two total groups was 57.9% in cryotherapy versus 89.6% in the brachytherapy group (P<0.0001). The 5-year bPFS was 70.0% (LRC), 51.4% (IRC), 89.4% (LRB) and 89.7% (IRB). The bPFS was significantly different between brachytherapy and cryotherapy for low and intermediate risk groups (p<0.05). The mean nadir temperature reached for cryotherapy patients was -35 (range: -6 to -96) degrees Celsius. Cryotherapy utilized a median of 2 (range: 2-4) freeze thaw cycles.ConclusionsResults from this study suggest that cryotherapy is inferior to brachytherapy for patients with low- to intermediate-risk prostate cancer. Patient selection criterion for consideration of cryotherapy and brachytherapy is similar in terms of anesthesia candidacy. Therefore, cryotherapy would not be recommended as a first-line local therapy for this particular patient subset.

Teaser

Currently no published evidence has compared clinical outcomes in prostate cancer for low-dose rate brachytherapy versus cryotherapy. A retrospective review was completed for these two modalities in low and intermediate risk localized prostate cancer. Brachytherapy was found to have significantly better biochemical progression free survival.


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