Embargoed: 00.01 hrs CEST Monday 27 April 2015
Prostate cancer patients who receive permanent radiotherapy implants twice
as likely to be free of cancer after five years
Barcelona, Spain: Results from a randomised controlled trial to compare the use of permanent
radioactive implants (brachytherapy) with dose-escalated external beam radiotherapy in patients
with prostate cancer show that the men who received brachytherapy were twice as likely to be
cancer-free five years later.
Presenting these results at the 3rd ESTRO Forum in Barcelona, Spain, today (Monday) Professor
James Morris, from the Department of Radiation Oncology, Vancouver Cancer Centre, British
Columbia Cancer Agency (BCCA), Vancouver, Canada, will say that the ASCENDE-RT1 trial is the
first and only existing trial comparing low-dose-rate prostate brachytherapy (LDR-PB) for the
curative treatment of prostate cancer with any other method of radiation therapy delivery.
The trial enrolled 398 men with cancer that had not spread outside the prostate gland who were
judged to be at high risk of treatment failure, based on standard tests for a number of features of the
cancer. The patients initially received androgen deprivation therapy (ADT), aimed at reducing levels
of the male hormones that stimulate prostate cancer cells to grow. After eight months of ADT, all
patients received 46 Gy2 of external beam radiotherapy to the prostate and regional lymph nodes.
Following this, 198 men received LDR-PB in which tiny radioactive seeds were implanted in the
prostate gland while under general or spinal anaesthesia. The other 200 patients were randomised
to dose-escalated external beam radiation therapy (DE-EBRT) and received an additional 32 Gy of
external beam radiation to achieve a total prostate dose of 78 Gy.
“At five years follow up, we saw a large advantage in progression-free survival in the LDR-PB
group,” Prof Morris will say. “Although, to date, overall survival and prostate cancer-specific
survival do not appear to differ between the two groups, existing trends favour LDR-PB and an
overall survival advantage is likely to emerge with longer follow-up.”
LDR-PB is an extremely cost-effective treatment, the researchers say, but it does require prolonged
training and experience in order to produce consistent results, and this may limit more widespread
adoption. An additional problem is that, in the trial, the LDR-PB patients experienced more urinary
side effects that those who received DE-EBRT. In a separate presentation Prof Morris’s Clinical
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Research Fellow, Dr Sree Rodda, told the conference that the incidence of severe late urinary side
effects was three times higher in patients who received LDR-PB than in those who had DE-EBRT.
“Many of these severe adverse effects were temporary and reversible, or could be ameliorated by
procedures. Moreover, more than 80% of patients in the LDR-PB arm had few or no long term
urinary side effects.” However, he says, “the long-term prevalence of severe urinary toxicity in the
LDR-PB patients was 8% compared to just 2% for the DE-EBRT patients. An important challenge
for the future will be the reduction of these adverse effects while maintaining the advantages of
LDR-PB.”
At BCCA’s five cancer centres, LDR-PB boost is now regarded as the standard of care for
unfavourable risk localised prostate cancer. “The ideal next step,” Prof Morris will say, “would be to
undertake randomised comparisons of LDR-PB boost against its principal alternatives – temporary
high-dose-rate brachytherapy implants (HDR-PB)3, stereotactic body radiation therapy using
extreme hypofractionation4, and combined surgery and post-operative radiation therapy.
“In the meantime, ASCENDE-RT has made an important contribution to the search for a more
effective curative treatment for prostate cancer,” he will conclude.
Professor Philip Poortmans, President of ESTRO, commented: “This study illustrates very nicely
how the best results can be obtained by combining various treatment options instead of trying to get
the most out of one single modality. Brachytherapy is an extremely efficient and safe radiation
oncology modality, and this trial shows that it can have a wider field of applicability than simply in
very localised and low risk tumours when combined with other techniques - in this case, androgen
deprivation therapy and external bean radiation therapy.”
(ends)
Morris: abstract no. OC-0485: “LDR Brachytherapy is Superior to 78 Gy of EBRT for Unfavourable
Risk Prostate Cancer: The Results of a Randomized Trial”, Highest scoring 3rd ESTRO Forum
abstracts session at 11.50 hrs (CEST) on Monday, 27 April, Main Auditorium.
Rodda: abstract no. PD-0047 GU and GI toxicity in ASCENDE-RT*: A Multicentre Randomized
Trial of Dose-Escalated Radiation for Prostate Cancer, poster session
When obtaining outside comment, journalists are requested to ensure that their contacts are
aware of the embargo on this release.
1. Androgen Suppression Combined with Elective Nodal and Dose Escanodal and Dose Escalated Radiation
Therapy.
2. A Gray, or Gy, is a measure of radiation dose, defined as the absorption of one joule of energy per kilogram
of tissue.
3. A radiation treatment using temporary implants to deliver high-dose-rate brachytherapy.
4. A form of external beam radiation therapy that delivers a few very large fractions of radiation using new
high precision technology.
5. The research was funded entirely by unrestricted educational grants to the BCCA from:
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Oncura Corporation (a subsidiary of GE Healthcare and the manufacturer of the radioactive seeds
used in the trial).
Sanofi-Aventis, Canada (the maker of the Suprefact and Eligard anti-androgen injections used in
the trial).
The 3rd ESTRO Forum is attended by about 3000 delegates from more than 80 countries. It features new
research results in clinical radiation oncology, radiobiology, physics, technology, and brachytherapy,
presented by top doctors and scientists from all over the world.
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