Long-term outcomes of external beam radiotherapy combined with high-dose-rate brachytherapy boost in intermediate- and high-risk prostate cancer
BackgroundFor intermediate- and high-risk prostate cancer, dose escalation is essential to optimize oncological control. While external beam radiotherapy (EBRT) alone can be limited by dose constraints to adjacent organs-at-risk, high-dose-rate (HDR) brachytherapy provides a highly conformal boost o...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
10 March 2026
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| In: |
Frontiers in oncology
Year: 2026, Volume: 16, Pages: 1-12 |
| ISSN: | 2234-943X |
| DOI: | 10.3389/fonc.2026.1765212 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.3389/fonc.2026.1765212 Verlag, kostenfrei, Volltext: https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1765212/full 
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| Author Notes: | Kerem Tuna Tas, Tristan Spartmann, Edgar Smalec, Phillip Lishewski, Fatima Frosan Sheikhzadeh, Martin Boettcher, Klemens Zink, Ioanna Fragkandrea-Nixon, Johannes Huber, Ahmed Gawish and Sebastian Adeberg |
| Summary: | BackgroundFor intermediate- and high-risk prostate cancer, dose escalation is essential to optimize oncological control. While external beam radiotherapy (EBRT) alone can be limited by dose constraints to adjacent organs-at-risk, high-dose-rate (HDR) brachytherapy provides a highly conformal boost option.MethodsThis retrospective single-institution study analyzed 250 patients with localized intermediate- and high-risk prostate cancer treated between 06/2004 and 03/2024 with EBRT plus HDR brachytherapy boost. The EBRT dose averaged 50.4 Gy (range: 45-64 Gy), followed by HDR boost in nearly all patients (98.8%) with two fractions of 9 Gy. Androgen deprivation therapy (ADT) was administered to 39.2% of patients (98/250). Primary outcomes included local control (LC), progression-free survival (PFS), and overall survival (OS).ResultsAfter a median follow-up of 63.5 months (mean 70.4, range 3-231), oncological outcomes were excellent. LC rates were 99.6% at 3 years, 98.8% at 5 years, and 98.4% at 10 years. PFS was 98%, 96.8%, and 96% at 3, 5, and 10 years, respectively. OS reached 98.4% at 5 years and 96% at 10 years. During the 231-month follow-up, 8.4% of patients developed biochemical recurrence, whereas in-field progression was observed in only 1.6%. Patients receiving ADT achieved 100% LC across all timepoints. Patterns of failure were predominantly distant (lymph nodes and bone). Acute and late toxicity was predominantly mild. No acute Grade ≥3 genitourinary (GU) or gastrointestinal (GI) toxicity was observed. Late Grade ≥3 toxicity was rare (0.8%, limited to GU events), and no late Grade ≥3 GI toxicity occurred.ConclusionsThe combination of EBRT and HDR brachytherapy boost yields outstanding long-term LC, PFS, and OS for intermediate- and high-risk prostate cancer, confirming this regimen as a highly effective treatment strategy. The dominant pattern of failure was distant, underscoring the need for optimized systemic therapy integration in high-risk patients. |
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| Item Description: | Veröffentlicht: 10. März 2026 Gesehen am 30.04.2026 |
| Physical Description: | Online Resource |
| ISSN: | 2234-943X |
| DOI: | 10.3389/fonc.2026.1765212 |