ASCENDE-RT: An Analysis of Treatment-Related Morbidity for A Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost to A Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer

Publication date: Available online 6 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Sree Rodda, Scott Tyldesley, W. James Morris, Mira Keyes, Ross Halperin, Howard Pai, Michael McKenzie, Graeme Duncan, Gerard Morton, Jeremy Hamm, Nevin Murray
PurposeTo report the genitourinary (GU) and gastrointestinal (GI) morbidity and erectile dysfunction in a randomized trial comparing two methods of dose escalation for high- and intermediate-risk prostate cancer.Materials and MethodsASCENDE-RT enrolled 398 men, median age 68 years, who were then randomized to either a standard arm that included 12 months of androgen deprivation therapy (ADT), pelvic irradiation to 46 Gy followed by a dose escalated-external beam radiation therapy (DE-EBRT) boost to 78 Gy, or an experimental arm that substituted a low-dose-rate prostate brachytherapy (LDR-PB) boost. At clinic visits, investigators recorded GU and GI morbidity and information on urinary continence, catheter use, and erectile function. Excluding 15 who received non-protocol treatment and correcting 14 crossovers events, leaves 195 men who actually received a DE-EBRT boost and 188 a LDR-PB boost. Median follow up is 6.5 years.ResultsLDR-PB boost increased the risk of needing temporary catheterization and/or requiring incontinence pads. At 5 years, the cumulative incidence of grade 3 GU events was 18.4% for LDR-PB versus 5.2% for DE-EBRT (p <0.001). Compared to the cumulative incidence, the 5-year prevalence of grade 3 GU morbidity was substantially lower for both arms (8.6% versus 2.2%, p =0.058). The 5-year cumulative incidence of grade 3 GI events was 8.1% versus 3.2% for LDR-PB and DE-EBRT (p =0.124). The 5-year prevalence of grade 3 GI toxicity was lower than the cumulative incidence for both arms (1.0% versus 2.2%). Among men reporting adequate baseline erections, 45% of LDR-PB patients reported similar erectile function at 5 years versus 37% after DE-EBRT (p =0.30).ConclusionsIncidence of acute and late GU morbidity was higher following LDR-PB boost and there was a non-significant trend for worse GI morbidity as well. No differences in the frequency of erectile dysfunction were observed.



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