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br comfortable to continue offering
comfortable to continue offering LDR-PB boost to our patients with intermediate-risk prostate cancer.
RESUME
Introduction : Il s’agit d’une etude retrospective menee pour faire rapport des resultats de contr^ole de la tumeur et de toxicite tardive chez les patients presentant un cancer de la prostate Lipo2000 risque inter-mediaire et recevant un traitement combine de radiotherapie par fais-ceau externe (EBRT) et de curietherapie adjuvante a faible dose (LDR-PB).
Methodologie et materiel : 31 patients ont rec¸u 45 Gray (Gy) of de radiotherapie par faisceau externe (EBRT) a la prostate et aux vesicules seminales, avec curietherapie adjuvante par implant trans-perineal 125I (108 Gy) dans la prostate. Certains patients ont egalement 
rec¸u six mois de traitement de privation androgenique, au choix du medecin. La defaillance biochimique etait definie en uti-lisant la definition de consensus de Phoenix de nadir d’APS a þ2 ng/ mL. La toxicite a ete mesuree selon le critere de toxicite CTCAE, version 4.0.
de 54,8% et de 6,5%. L’incidence de toxicite GU tar-dive de grade 3 etait de 6,5%, avec, chez deux patients, une incidence de retention urinaire exigeant soit une incision du col de la vessie (BNI) ou une resection transuretrale de la prostate (TURP). L’inci-dence de toxicite gastrointestinale (GI) tardive de grade >1 and 2
* Corresponding author. Michael Chao, FRANZCR, Genesis Cancer Care Victoria, 36 Mt Dandenong Road, Ringwood East, Victoria 3135, Australia. E-mail address: [email protected] (M. Chao).
etait respectivement de 19,4% et de 6,5%. Aucun patient n’a developpe de toxicite GI de grade 3.
Conclusion : Notre petit echantillon a revele un bPFS eleve, consis-tent avec les etudes LDR-PB ASCENDE-RT et NRG Oncology/ RTOG0232 LDR-PB. Par ailleurs, le risque de toxicite tardive GU
Keywords: Prostate cancer; brachytherapy boost; external beam radiotherapy
de grade 3 est beaucoup plus faible que celui constate par l’etude ASCENDE-RT et comparable a celui des autres etudes LDR-PB et LDR publiees. Par consequent, nous sommes a l’aise de continuer a offrir la therapie adjuvante LDR-PB a nos patients presentant un cancer de la prostate a risque intermediaire.
Introduction
The combination of external beam radiotherapy (EBRT) with a brachytherapy boost for intermediate- and/or high-risk prostate cancer has shown to be superior to high dose EBRT alone for biochemical progression-free survival (bPFS) [1–3]. In the Androgen suppression combined with elective nodal and dose escalated radiation therapy (ASCENDE-RT) study, patients were randomized to combination EBRT with a low dose rate brachytherapy boost (LDR-PB) vs. dose-escalated EBRT alone. Men randomized to the LDR-PB boost arm were twice as likely to be free of biochemical failure than men who had high dose EBRT alone [1]. However, this improvement in bPFS was offset by a significantly increased risk of late grade 3 genitouri-nary (GU) toxicity in the LDR-PB boost arm. To date we have not seen an improvement in overall survival (OS) after a median follow-up of 6.5 years.
Whether this considerable difference in bPFS (estimated 9-year Kaplan–Meier bPFS 83% for LDR boost vs. 62% for EBRT alone) will translate to an improvement in metastases-free survival (MFS) or OS with extended follow-up is still currently unknown. Fuks et al [4] have hypothesized that local recurrence can lead to a second wave of metastases, which may impact on MFS and eventually OS. This may well have signif-icant consequences for men with a long life expectancy, who choose radiotherapy (RT) as their primary treatment modality. Any discussions involving RT will need to include not only EBRT but also in combination with a brachytherapy boost, as the large difference in bPFS with extended follow-up may potentially impact on their MFS and/or OS.