Highly rated.

We’re talking high-dose rate (HDR) brachytherapy. We know low-dose rate (LDR) brachy boosts improve biochemical control in the treatment of unfavorable prostate cancer, with suggestions of improvement in overall survival. How can it get better? For many of the same reasons HDR has supplanted LDR in gynecologic cancers, many suggest HDR boosts for prostate cancer may raise dose accuracy and thus lower toxicity—the oft-cited downside of prostate brachy boosts. The latest NCDB iteration of this debate compares survival outcomes following boosts via [1] external beam, [2] HDR, and [3] LDR techniques among nearly 123K men with intermediate or higher risk prostate cancer. Once again, the standout loser was dose-escalated external beam alone with a significant adjusted hazard ratio for death of 1.4 when compared to LDR boosts. On the other hand, survival outcomes following HDR boosts were virtually identical to those seen with LDR with a non-significant adjusted hazard ratio of 1.0. TBL:Prospective studies will likely prove HDR brachy boosts afford similar prostate cancer outcomes as LDR with the hope of less toxicity. | King, Brachytherapy 2019