Hemiablative Focal Low Dose Rate Brachytherapy: A Phase II Trial Protocol

Ana Fernandez Ots, Joseph Bucci, Yaw Sinn Chin, David Malouf, Andrew Howie, Komiti Ese Enari, Ana Fernandez Ots, Joseph Bucci, Yaw Sinn Chin, David Malouf, Andrew Howie, Komiti Ese Enari

Abstract

Background: The objective of focal brachytherapy (BT) is to provide effective prostate cancer control for low-risk disease but with reduced genitourinary, gastrointestinal and sexual side effects in a cost-effective way.

Objective: The aim of this study is to describe a phase II study examining technical and dosimetric feasibility and toxicity, quality of life changes, and local control with post-treatment biopsy outcomes in men with early stage low volume prostate cancer treated with focal iodine-125 seed BT.

Methods: The study design is a prospective, multicenter trial with a planned sample size of 20 patients including men with a minimum age of 60 years, a life expectancy estimated to be greater than 10 years, with low or low-tier intermediate risk prostate cancer, unilateral disease on the biopsy, and a Gleason score of ≤3+4 and <25% cores involved. The investigations specific for the study are multi-parametric magnetic resonance imaging (Mp-MRI) baseline, at 20 and 36 months to rule out high grade disease and a transperineal mapping biopsy (baseline and at 36 months) for more accurate patient selection. The hemigland region will receive 144 Gy. Standard normal tissue constraints will be considered as for a whole gland (WG) implant. Dosimetric parameters will be evaluated at day 30 after the implant. Toxicity and quality of life will be evaluated with international validated questionnaires focusing on urinary, rectal, sexual domain, and general health-related quality of life. The patients will complete this assessment at baseline and then approximately every 6 months after the implant up to 10 years.

Results: To date, one patient is involved in the trial. He underwent the pre-implant investigations which found bilateral disease. Therefore, a standard seed implant was performed. If the results from this trial provide evidence that the treatment is safe, feasible, and improves toxicity, funding will be sought to conduct a large, multicenter, randomized controlled trial (RCT).

Conclusions: This protocol is designed to show feasibility in delivering hemigland focal therapy with seed BT. It may answer crucial questions and obtain data which will enable downstream decisions on focal low dose rate (LDR) prostate BT.

Clinicaltrial: Clinicaltrial.gov NCT02643511; https://www.clinicaltrials.gov/ct2/show/NCT02643511 (Archived by Webcite at http://www.webcitation.org/6ghLCzIhY).

Keywords: cancer research; focal therapy; prostate.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Trial schema.
Figure 2
Figure 2
Transperineal template. Diagram prepared by Warick Delprado at Douglass Hanly Moir Pathology and used by permission.
Figure 3
Figure 3
Hemiablation.
Figure 4
Figure 4
The necessary data to be collected at various time points of the study.

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