Radiation therapy plays an important role in the management of prostate cancer. In recent years it has become evident that higher doses of radiation are required to optimize disease control. The limiting factor of escalating dose to the prostate is the surrounding normal tissue. Despite advances in escalating radiation therapy, failures still occur in 20-30% of patients most often at the site of the original primary disease. As such there is growing interest in further dose escalating to the area of primary disease burden.The aim of this work is to look at the feasibility and toxicities of an integrated focal boost to whole gland prostate treatment using high dose rate brachytherapy.
This study is a pilot study of 60 patients look at the toxicities, biochemical and patient reported quality of life outcomes of an MR-integrated focal boost using HDR prostate brachytherapy. Eligible patients for this study will be determined by pre-brachytherapy MRI (DCE, T2 weighted and diffusion weighted) imaging, to identify a dominant intraprostatic lesion. The HDR dose prescription is 19 Gy to the whole gland ad 22.5 Gy to MRI visible lesion delivered in one fraction, assuming that dose constraints to critical organs can be met.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Prior to brachytherapy treatment, a multiparametric MRI will be obtained for identification of the dominant intraprostatic lesion (DIL) and fused with the preplanning transrectal ultrasound. A total of 19 Gy will be prescribed to the prostate, organ at risk limits will be observed and up to 22.5 Gy can be delivered to the DIL
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
Acute GU and GI toxicities
Measured according to NCI CTCAE v4.0
Time frame: 3mo
Late GU and GI toxicities
Measured according to NCI CTCAE v4.0
Time frame: 5 years
Quality of life changes
Patient reported outcome utilizing Expanded Prostate Index Composite (EPIC)
Time frame: 5 years
Changes in urinary symptoms
Patient reported outcome utilizing International Prostate Symptom Score (IPSS)
Time frame: 5 years
Changes in serum prostate-specific antigen (PSA)
Time frame: 5 years
PSA failure and disease-free survival rates
Time frame: 5 years
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