Site Overlay

High dose rate brachytherapy – long term results

Volume 10, Issue 2

Original Article / Published: November 2022


B. Genova, V. Parvanova, I. Mihaylova

Clinic of radiotherapy, National Oncology Hospital (USBALO), Sofia, Bulgaria


Introduction and objective: High-dose-rate brachytherapy with a temporary implant is one of the alternative methods for the treatment of localised prostate carcinoma, along with radical prostatectomy and external beam radiation therapy. The objective of this study is to analyze the long-term treatment results after definitive high-dose-rate brachytherapy for localised prostate carcinoma in USBALO.

Material and methods: For the period from January 2011 to January 2019, 90 patients were treated with HDR-brachytherapy (with a temporary implant) in the Radiotherapy Department of USBALO. The average age is 66.5 years (53÷78 years). Patients are divided into low risk group – 54 (60%) and intermediate risk due to the presence of 1 negative factor – 36 (40%) patients. Follow-up ranged from 16 to 129 months (mean 84 months or 7 years). For the area of ​​the prostate and the base of the seminal vesicles, 20 (22.2%) patients received 3 fractions of 10.5 Gy over 14 days, and 70 (77.8%) received a dose of 3 x 11 Gy.

Results: During the follow-up period, biochemical control was established in 78 patients (86.7%). Five-year biochemical control for all patients was 90%, and the 10-year biochemical control – 86.7%. Long-term follow-up of patients shows 5- and 10-year biochemical progression-free survival of 87.9% and 79.7%, respectively.

Conclusions: Definitive high-dose-rate brachytherapy provides excellent long-term outcomes in low-risk and favorable intermediate-risk patients with localised prostate cancer in our data compared with those reported to date.


  1. Yamada Y, Rogers L, Demanes DJ, Morton G, Prestidge BR, Pouliot J, Cohen GN, Zaider M, Ghilezan M, Hsu IC; American Brachytherapy Society. American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy. 2012 Jan-Feb;11(1):20-32. doi: 10.1016/j.brachy.2011.09.008.
  2. N. Mottet, P. Cornford, R.C.N. van den Bergh, et al. Members of the EAU Guidelines Panel. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate cancer. Available at: Accessed November 6th, 2022.
  3. 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 Jul 15;65(4):965-74. doi: 10.1016/j.ijrobp.2006.04.029.
  4. Ghilezan M, Martinez A, Gustason G, Krauss D, Antonucci JV, Chen P, Fontanesi J, Wallace M, Ye H, Casey A, Sebastian E, Kim L, Limbacher A. High-dose-rate brachytherapy as monotherapy delivered in two fractions within one day for favorable/intermediate-risk prostate cancer: preliminary toxicity data. Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):927-32. doi: 10.1016/j.ijrobp.2011.05.001.
  5. Zelefsky MJ, Pei X, Chou JF, Schechter M, Kollmeier M, Cox B, et al. Dose escalation for prostate cancer radiotherapy: predictors of long-term biochemical tumor control and distant metastases-free survival outcomes. Eur Urol. 2011 Dec;60(6):1133-9. doi: 10.1016/j.eururo.2011.08.029.
  6. 6.Nguyen QN, Levy LB, Lee AK, Choi SS, Frank SJ, Pugh TJ, et al. Long-term outcomes for men with high-risk prostate cancer treated definitively with external beam radiotherapy with or without androgen deprivation. Cancer. 2013 Sep 15;119(18):3265-71. doi: 10.1002/cncr.28213
  7. Yamada Y, Rogers L, Demanes DJ, Morton G, Prestidge BR, Pouliot J, et al.; American Brachytherapy Society. American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy. 2012 Jan-Feb;11(1):20-32. doi: 10.1016/j.brachy.2011.09.008.
  8. Hoskin PJ, Colombo A, Henry A, Niehoff P, Paulsen Hellebust T, Siebert FA, Kovacs G. GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: an update. Radiother Oncol. 2013 Jun;107(3):325-32. doi: 10.1016/j.radonc.2013.05.002.
  9. Mark R, Anderson P, Akins R. Interstitial high-dose-rate brachytherapy as monotherapy for early stage prostate cancer: median 8-year results in 301 patients. (Abstract). Brachytherapy 2010;9:76.
  10. Hoskin P, Rojas A, Lowe G, Bryant L, Ostler P, Hughes R, Milner J, Cladd H. High-dose-rate brachytherapy alone for localized prostate cancer in patients at moderate or high risk of biochemical recurrence. Int J Radiat Oncol Biol Phys. 2012 Mar 15;82(4):1376-84. doi: 10.1016/j.ijrobp.2011.04.031.
  11. Barkati M, Williams SG, Foroudi F, Tai KH, Chander S, van Dyk S, See A, Duchesne GM. High-dose-rate brachytherapy as a monotherapy for favorable-risk prostate cancer: a Phase II trial. Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):1889-96. doi: 10.1016/j.ijrobp.2010.09.006.
  12. Zamboglou N, Tselis N, Baltas D, Buhleier T, Martin T, Milickovic N, Papaioannou S, Ackermann H, Tunn UW. High-dose-rate interstitial brachytherapy as monotherapy for clinically localized prostate cancer: treatment evolution and mature results. Int J Radiat Oncol Biol Phys. 2013 Mar 1;85(3):672-8. doi: 10.1016/j.ijrobp.2012.07.004.
  13. Yoshioka Y, Suzuki O, Isohashi F, Seo Y, Okubo H, Yamaguchi H, et al. High-Dose-Rate Brachytherapy as Monotherapy for Intermediate- and High-Risk Prostate Cancer: Clinical Results for a Median 8-Year Follow-Up. Int J Radiat Oncol Biol Phys. 2016 Mar 15;94(4):675-82. doi: 10.1016/j.ijrobp.2015.05.044.
  14. Jawad MS, Dilworth JT, Gustafson GS, Ye H, Wallace M, Martinez A, Chen PY, Krauss DJ. Outcomes Associated With 3 Treatment Schedules of High-Dose-Rate Brachytherapy Monotherapy for Favorable-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys. 2016 Mar 15;94(4):657-66. doi: 10.1016/j.ijrobp.2015.10.011.
  15. Hauswald H, Kamrava MR, Fallon JM, Wang PC, Park SJ, Van T, Borja L, Steinberg ML, Demanes DJ. High-Dose-Rate Monotherapy for Localized Prostate Cancer: 10-Year Results. Int J Radiat Oncol Biol Phys. 2016 Mar 15;94(4):667-74. doi: 10.1016/j.ijrobp.2015.07.2290.
  16. Morton G, McGuffin M, Chung HT, Tseng CL, Helou J, Ravi A, et al. Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: Efficacy results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy. Radiother Oncol. 2020 May;146:90-96. doi: 10.1016/j.radonc.2020.02.009.
  17. Armstrong S, Tsang Y, Lowe G, Tharmalingam H, Alonzi R, Ostler P, Hughes R, Hoskin P. Dosimetry of local failure with single dose 19 Gy high-dose-rate brachytherapy for prostate cancer. Radiother Oncol. 2021 Apr;157:93-98. doi: 10.1016/j.radonc.2021.01.006.
  18. Viani GA, Arruda CV, Assis Pellizzon AC, De Fendi LI. HDR brachytherapy as monotherapy for prostate cancer: A systematic review with meta-analysis. Brachytherapy. 2021 Mar-Apr;20(2):307-314. doi: 10.1016/j.brachy.2020.10.009.
  19. Anderson EM, Kim S, Sandler HM, Kamrava M. High-dose-rate fractionated brachytherapy monotherapy for localized prostate cancer: a systematic review and meta-analysis. J Contemp Brachytherapy. 2021 Aug;13(4):365-372. doi: 10.5114/jcb.2021.108590.
Volume 10, Issue 2


high-dose-rate brachytherapy; localised prostate carcinoma; temporary implant

How to cite this article:

Genova B, Parvanova V, Mihaylova I. Hight dose rate brachytherapy – long term results. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2022; 10(2): 29-37

Corresponding author:

Dr. Boryana Genova

Clinic of radiotherapy
National Oncology Hospital (USBALO)
6, Plovdivsko pole str.
1797 Sofia, Bulgaria

E-mail:; Phone: +359 885 413 234