Thang Nguyen
Epworth Radiation Oncology
Radiation Therapist

Emma Fitzgerald
Radiation Therapist
Epworth Radiation Oncology

Background: Low Dose Rate (LDR) prostate brachytherapy encompasses the whole gland, where it may be associated with erectile dysfunction, incontinence and rectal toxicity (1). Recently, LDR brachytherapy has been considered for use in a focused manner. This has become feasible owing to more thorough pre-treatment radiological and pathological assessment that may more aptly identify the dominant lesion (2).

Purpose: The purpose of this poster is to share our experience in the treatment of the first 4 focal prostate brachytherapy patients in our department.

Methods: Between 2015 and 2017, a total of 4 focal brachytherapy patients were treated. All 4 patients had had pre-treatment MRI to identify the dominate nodule. This was subsequently fused in Variseed planning system with the initial volume study to determine a PTV, treated to a dose of 145Gy.

Result: Patients’ clinical response and PSA response were evaluated. Post implant dosimetry of the 4 patients analysed demonstrated satisfactory V200%, V150%, V100% and D90%. At initial follow up, virtually no clinically meaningful toxicity to both rectum and neurovascular bundle were observed. Other clinical endpoints such as disease control and PSA response remain under active assessment and will be reported in due course.

Conclusion: The aim of focal brachytherapy is to provide effective cancer control for low-risk disease with reduced genitourinary and rectal side effects. Long term follow up is required to assess late rectal, urethral toxicities, and to determine the rate of local disease control in men following low dose rate focal brachytherapy. We have successfully managed 4 patients on a pilot protocol and will further this initiative in a formalised phase II environment.

1. Sylvester JE , Grimm PD , Wong J , Galbreath RW , Merrick G , Blasko JC . Fifteen-year biochemical relapse-free survival, cause-specifi c survival, and overall survival following I(125) prostate brachytherapy in clinically localized prostate cancer: Seattle experience . Int J Radiat Oncol Biol Phys 2011 ; 81 : 376 – 81

2. Jain AK and Ennis RD. Focal Therapy, Differential Therapy, and Radiation Treatment for Prostate Cancer. Adv Urol. 2012; 2012: 573193

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