Work

High-Dose-Rate Brachytherapy Boost for Prostate Cancer: A Retrospective Observational Study in Low- and Middle-Income Countries

Year: 2025

Type: article

Abstract: Prostate brachytherapy used as an adjunct to external beam radiation therapy (EBRT) is recognized as an effective therapeutic approach in the treatment of intermediate- and high-risk prostate cancer. However, data remain limited in African countries, particularly Morocco. The aim of this study was to assess the oncological outcomes and tolerability of boost brachytherapy in a Moroccan cohort. Material and method A retrospective study was conducted between 2014 and 2022. Among 128 patients treated with prostate brachytherapy, 106 with intermediate- or high-risk prostate cancer who received high dose rate (HDR) brachytherapy as a boost were included. Hormone therapy was administered to 84.91% of patients. Median follow-up was 26 months. Clinical characteristics, dosimetric data, toxicity and oncological results were analyzed. Results Of the 106 patients, 59 (55.66%) had intermediate-risk cancer and 47 (44.34%) had high-risk cancer. Locally advanced stage (T3a-T3b) was observed in 43.4% of patients. At 3 years, overall survival (OS), metastasis-free survival (MFS) and biochemical progression-free survival (BPFS) were 87%, 92% and 78% respectively. The 3-year BPFS was 75% for intermediate-risk cancers and 70% for high-risk cancers. ISUP scores 1 to 3 showed better BPFS (85%) and MFS (92%) than ISUP scores 4 to 5 (BPFS: 60%, MFS: 79%). Clinical stage was the only significant factor for MFS (p = 0.001). No grade 3 acute toxicities (GU or GI) were reported. Late grade 3 toxicities were observed in 1.89% (GU) and 0.94% (GI) of patients. Grade 2 toxicities remained low (<9%). Conclusion This single-center study confirms the efficacy and tolerability of the combination of EBRT and brachytherapy in the treatment of intermediate- and high-risk prostate cancer. The results are encouraging, even in advanced-stage patients. Clinical stage has been shown to be the main prognostic factor for metastasis-free survival.

Source: Advances in Radiation Oncology

DOI: 10.1016/j.adro.2025.101861