Research Article

EFFECTS OF BRACHYTHERAPY BOOST ON PROSTATE CANCER TREATED WITH EXTERNAL BEAM RADIOTHERAPY: A PILOT STUDY

1 Department of Radiation Oncology, University of Ibadan/University College Hospital, Ibadan.
2 Department of Radiation Oncology, University College Hospital, Ibadan PMB 5116, Nigeria.
3 NSIA – LUTH Cancer Centre, Lagos state.
4 Radiation Oncology Department, University College Hospital, Ibadan, Oyo State, Nigeria
5 Department of Radiation Biology, Radiotherapy & Radiodiagnosis, College of Medicine, University of Lagos, Lagos.
6 Department of Radiation Oncology, Obafemi Awolowo University Teaching Hospital, Ile-Ife.
7 Department of Radiation Oncology, University of Ibadan/University College Hospital (UCH), Ibadan, Oyo State, Nigeria
* Corresponding author: mailolabissy@yahoo.com
Published: Jul, 2025
Pages: 300-312
Views: 279
Downloads: 188

Abstract

Background: Prostate cancer is the leading cause of cancer amongst men in Nigeria. External beam radiotherapy (EBRT) and high-dose rate brachytherapy (HDR-BT) play a significant role in the management of localised prostate cancer.


Objective: This study compared the treatment outcome of the management of intermediate and high-risk localised prostate cancer patients using EBRT alone and EBRT + BT.


Methods: A pilot study was conducted at the University College Hospital, Ibadan, and the Lagos University Teaching Hospital. Thirty-eight (38) patients were recruited, with 19 patients in both EBRT alone and EBRT+BT arms. Biochemical-free survival (BFS), late side effects, and quality of life (QoL) were assessed and compared across both arms. Biochemical free survival was calculated using the Kaplan-Meier survival curve and compared using log log-rank test, quality of life was assessed using the EORTC quality of life questionnaire and mean compared using the t-test. Late side effects were assessed using the RTOG questionnaire and compared using chi-square. Ethical approval was obtained from both institutions.


Results: Twenty-seven percent (23%) of the patients recruited had intermediate-risk disease, while seventy-three percent (73%) had high-risk disease, with ADT used before radiotherapy in 71.1%. The mean EQD2 in the EBRT arm and EBRT+BT arm was 63.0Gy and 81.5Gy, respectively. BFS at 12 months was 81.8% and 88.2% for EBRT and EBRT+BT, respectively. Mean time to biochemical recurrence was 11.46 months and 11.82 months for EBRT and EBRT+BT, respectively (p=0.625). All biochemical failures occurred among the high-risk group, with BFS at 12 months being 71.4% and 84.6% for EBRT and EBRT+BT, respectively (p=0.468). Grade 1 and 2 late Genitourinary toxicities were more in the EBRT arm (10.5% and 52.6% respectively) compared to the EBRT+BT arm (5.3% and 15.8% respectively) (P=0.03). Comparison of Gastrointestinal late toxicities, QoL, and sexual function in both arms was not statistically significant.


Conclusion: BFS was similar in both treatment arms; however, the EBRT+BT arm had fewer genitourinary side effects than the EBRT arm. Gastrointestinal toxicities, QoL, and sexual dysfunction had comparative incidence in both arms.


References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi: 10.3322/caac.21660
  2. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Prostate cancer. Version 1.2023-September 16,2022. Available at www.nccn.org/patients
  3. Mendez LC, Morton GC. High dose-rate brachytherapy in the treatment of prostate cancer. Transl Androl Urol. 2018 Jun;7(3):357–70.
  4. INTERNATIONAL ATOMIC ENERGY AGENCY, Strategies for the Management of Localised Prostate Cancer: A Guide for Radiation Oncologists, IAEA Human Health Reports No. 11, IAEA, Vienna. 2014
  5. Hayden AJ, Martin JM, Kneebone AB, Lehman M, Wiltshire KL, Skala M, et al. Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group: 2010 consensus guidelines for definitive external beam radiotherapy for prostate carcinoma. Journal of medical imaging and radiation oncology. 2010: 54(6);513–525.
  6. Abdus-salam AA, Takure OA, Akinlade BI, Idowu OK, Folorunso SA, Olabumuyi AA, et al. Early Experience of High-Dose Rate Interstitial Brachytherapy for Prostate Cancer in Nigeria. Journal of Radiation Medicine in the Tropics. 2023;4(1): 1-5.
  7. Roach M 3rd, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, Sandler H. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006;65(4):965-74.
  8. Thames H, Kuban D, Levy L, Horwitz EM, Kupelian P, Martinez A, et al. Comparison of alternative biochemical failure definitions based on clinical outcome in 4839 prostate cancer patients treated by external beam radiotherapy between 1986 and 1995. Int J Radiat Oncol Biol Phys. 2003;57(4):929-43.
  9. Khor R, Duchesne G, Tai KH, Foroudi F, Chander S, Van Dyk S, et al. Direct 2-arm comparison shows benefit of high-dose-rate brachytherapy boost vs external beam radiation therapy alone for prostate cancer. Int J Radiat Oncol Biol Phys. 2013;85(3):679-85.
  10. Oshikane T, Kaidu M, Abe E, Ohta A, Saito H, Nakano T, et al. A comparative study of high-dose-rate brachytherapy boost combined with external beam radiation therapy versus external beam radiation therapy alone for high-risk prostate cancer. Journal of radiation research. 2021;62(3):525–532.
  11. Ikuerowo SO, Omisanjo OA, Bioku MJ, Ajala MO, Mordi VP, Esho JO. Prevalence and characteristics of prostate cancer among participants of a community-based screening in Nigeria using serum prostate-specific antigen and digital rectal examination. Pan Afr Med J. 2013 Aug 10;15:129.
  12. Amegbor K, Seddoh TY, Tengue K, Songne-Gnamkoulamba B, Napo-Koura G, James K. Epidemiologie et histopronostic du cancer de la prostate au Togo: a propos de 202 cas diagnostiques au laboratoire d'anatomie pathologique du CHU Tokoin de Lome. Progres en urologie. 2009;19(2):112–115.
  13. Gueye SM, Jalloh M, Labou IE, Niang L, Kane R, Ndoye M. Profil clinique du cancer de la prostate au Senegal. Afr J Urol. 2004;10(3):203–207.
  14. Hoskin PJ, Rojas AM, Bownes PJ, Lowe GJ, Ostler PJ, Bryant L. Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer. Radiother Oncol. 2012;103(2):217-22.
  15. Abdus-Salam AA, Jimoh MA, Folasire AM, Ntekim AI, Ojo OT, Ehiedu CG, et al. Sociodemographic and clinicopathologic characteristics of patients treated with high dose rate prostate brachytherapy in Nigeria. Ecancermedicalscience. 2024;18:1740.
  16. Hoskin PJ, Motohashi K, Bownes P, Bryant L, Ostler P. High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial. Radiother Oncol 2007;84:114–20.
  17. Roy A, Brenneman RJ, Hogan J, Barnes JM, Huang Y, Morris R, et al. Does the sequence of high-dose rate brachytherapy boost and IMRT for prostate cancer impact early toxicity outcomes? Results from a single institution analysis. Clinical and translational radiation oncology. 2021;29:47–53.
  18. Ahmadsei M, Christ SM, Seiler A, Vlaskou Badra E, Willmann J, Hertler C, Guckenberger M. Quality-of-life and toxicity in cancer patients treated with multiple courses of radiation therapy. Clin Transl Radiat Oncol. 2022;34:23-29.
  19. Maiwand Ahmadsei, Sebastian M. Christ, Annina Seiler, Eugenia Vlaskou Badra, Jonas Willmann, Caroline Hertler, Matthias Guckenberger (2022). Quality-of-life and toxicity in cancer patients treated with multiple courses of radiation therapy, Clinical and Translational Radiation Oncology, 34, 23-29.
How to Cite

Abdus-salam, A. A., Ojo, O. T., Ehiedu, C., Bashir, M. A., Ntekim, A. I., Alabi, A. O., Folorunso, S. A., alani, J. M., Sarimiye, F. O., & Adenipekun, A. (2025). EFFECTS OF BRACHYTHERAPY BOOST ON PROSTATE CANCER TREATED WITH EXTERNAL BEAM RADIOTHERAPY: A PILOT STUDY. Nigerian Journal of Oncology, 1(2), 300-312. https://doi.org/10.67579/njo.2025.bfjzda3v

A. A. Abdus-salam, O. T. Ojo, C. Ehiedu, M. A. Bashir, A. I. Ntekim, A. O. Alabi, S. A. Folorunso, J. M. alani, F. O. Sarimiye, and A. Adenipekun, "EFFECTS OF BRACHYTHERAPY BOOST ON PROSTATE CANCER TREATED WITH EXTERNAL BEAM RADIOTHERAPY: A PILOT STUDY," Nigerian Journal of Oncology, vol. 1, no. 2, pp. 300-312, July 2025. doi: 10.67579/njo.2025.bfjzda3v

Share this article:
Facebook X / Twitter LinkedIn