ArticleFrontiers in oncology2026
Long-term outcomes of external beam radiotherapy combined with high-dose-rate brachytherapy boost in intermediate- and high-risk prostate cancer.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: For intermediate- and high-risk prostate cancer, dose escalation is essential to optimize oncological control. While external beam radiotherapy (EBRT) alone can be limited by dose constraints to adjacent organs-at-risk, high-dose-rate (HDR) brachytherapy provides a highly conformal boost option. Methods: This retrospective single-institution study analyzed 250 patients with localized intermediate- and high-risk prostate cancer treated between 06/2004 and 03/2024 with EBRT plus HDR brachytherapy boost. The EBRT dose averaged 50.4 Gy (range: 45-64 Gy), followed by HDR boost in nearly all patients (98.8%) with two fractions of 9 Gy. Androgen deprivation therapy (ADT) was administered to 39.2% of patients (98/250). Primary outcomes included local control (LC), progression-free survival (PFS), and overall survival (OS). Results: After a median follow-up of 63.5 months (mean 70.4, range 3-231), oncological outcomes were excellent. LC rates were 99.6% at 3 years, 98.8% at 5 years, and 98.4% at 10 years. PFS was 98%, 96.8%, and 96% at 3, 5, and 10 years, respectively. OS reached 98.4% at 5 years and 96% at 10 years. During the 231-month follow-up, 8.4% of patients developed biochemical recurrence, whereas in-field progression was observed in only 1.6%. Patients receiving ADT achieved 100% LC across all timepoints. Patterns of failure were predominantly distant (lymph nodes and bone). Acute and late toxicity was predominantly mild. No acute Grade ≥3 genitourinary (GU) or gastrointestinal (GI) toxicity was observed. Late Grade ≥3 toxicity was rare (0.8%, limited to GU events), and no late Grade ≥3 GI toxicity occurred. Conclusions: The combination of EBRT and HDR brachytherapy boost yields outstanding long-term LC, PFS, and OS for intermediate- and high-risk prostate cancer, confirming this regimen as a highly effective treatment strategy. The dominant pattern of failure was distant, underscoring the need for optimized systemic therapy integration in high-risk patients.
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