Radiation Therapy Research Reveals Insights into Brachytherapy Treatments for Prostate Cancer

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Recent research presented at a conference in Boston has shed light on the effectiveness of different external beam radiation therapy (EBRT) dosing regimens prior to brachytherapy in patients with clinically localized prostate cancer. The study, led by researchers from the Dana-Farber Cancer Institute, aimed to evaluate whether different dosing regimens affected biochemical failure (BF) in patients.

Key Takeaways:

  • The 44/20 and 20/0 randomized trials evaluated the effectiveness of different EBRT dosing regimens prior to brachytherapy in patients with clinically localized prostate cancer.
  • The trials enrolled patients with clinical T1c to T2b, Gleason scores 7 to 9, and/or a pretreatment prostate-specific antigen (PSA) 10 to 20 ng/mL disease.
  • The 44/20 trial randomized patients to 44 Gy EBRT with 90 Gy palladium (Pd)-103 versus 20 Gy EBRT with 115 Gy Pd-103, while the 20/0 trial randomized patients to the 20 Gy arm versus monotherapeutic 125 Gy Pd-103.
  • The research found no differences in biochemical failure (BF) for the entire cohort or the unfavorable intermediate-risk (UIR) subgroup in both trials.
  • The combined trial cohort analysis of 630 patients found that biological equivalent dose (BED) was not associated with BF on multivariate analyses while adjusting for androgen deprivation therapy utilization, 4-tiered National Comprehensive Cancer Network category, and year of treatment.
  • The research concluded that brachytherapy monotherapy should be a standard-of-care treatment for clinically localized, intermediate-risk prostate cancer, including UIR disease.

Statistics:

  • 247 analyzable patients in the 44/20 trial had a median follow-up of 13.7 years.
  • 383 analyzable patients in the 20/0 trial had a median follow-up of 10.4 years.
  • The combined cohort of 630 patients had a median follow-up of 11.9 years.
  • 44/20 and 20/0 trials had no differences in biochemical failure (BF) for the entire cohort or the unfavorable intermediate-risk (UIR) subgroup.
  • The combined trial cohort analysis found that BED was not associated with BF (1.00; 95% CI, 0.98-1.02; P = 0.88).

Sources:

  • "Prospective Evaluation of Supplemental External Beam Radiation Therapy With Palladium-103 Prostate Brachytherapy: Long-term Results of the 44/20/0 Trials." Practical Radiation Oncology, 2025;15(3).
  • NewsRx. Researchers from Dana-Farber Cancer Institute Describe Findings in Radiation Therapy (Prospective Evaluation of Supplemental External Beam Radiation Therapy With Palladium-103 Prostate Brachytherapy: Long-term Results of the 44/20/0 Trials). Health & Medicine Week. June 13, 2025; p 5940.