Long-term outcomes from a multicentre study of HDR monotherapy with a single fraction of 19 Gy for localized prostate cancer
Sittiwong, W. Lydon, A. Wylie, J. Ahmed, I. Challapalli, A. Hoskin, P.
Sittiwong, W.
Lydon, A.
Wylie, J.
Ahmed, I.
Challapalli, A.
Hoskin, P.
Abstract
OBJECTIVES: To evaluate long-term clinical outcomes, toxicity, and prognostic factors in patients with localized prostate cancer treated with single-fraction high-dose-rate (HDR) brachytherapy. METHODS: This multicentre retrospective study included patients from five UK centres who received a single 19 Gy HDR brachytherapy fraction under a standardized protocol. Kaplan-Meier estimates were calculated at median 5 and 8 years for biochemical progression-free survival (bPFS), local recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Prognostic factors were assessed using Cox regression. Toxicities were graded using CTCAEv3.0. Quality of life (QoL) was evaluated using IPSS, IIEF, and FACT-P questionnaires. RESULTS: A total of 320 patients were included, with a median follow-up of 94 months. Five- and 8-year rates were: bPFS 77.1%/66.5%, LRFS 96.1%/90.9%, NRFS 98.3%/97.3%, DMFS 95.9%/93.8%, and OS 91.4%/87.0%. Low-risk patients had significantly better bPFS than intermediate and high-risk (HR12.55, 95%CI:1.74-90.05,p = 0.012), though no significant differences were seen in other outcomes. Subcentimetre pelvic lymph nodes on MR scan were associated with poorer bPFS, LRFS, DMFS, and OS. GS ≥ 8 predicted worse OS. Acute and late ≥ grade 2 GU toxicities occurred in 3.1% and 19.3% of patients, respectively; GI toxicities in 0.8% and 1.5%. QoL scores worsened post-treatment: IPSS + 7 points (p < 0.001), IIEF -9 points (p = 0.043), and FACT-P -3 points (p = 0.02) and returned to baseline. CONCLUSION: Single-fraction 19 Gy HDR brachytherapy was tolerable and provided disease control, though contemporary practice favors active surveillance for most low-risk patients. For higher-risk disease, a single fraction is not equivalent to standard multifraction regimens, indicating its role should remain limited.
Description
Date
2026
Publisher
Collections
Keywords
Type
Article
Citation
Sittiwong W, Lydon A, Wylie J, Ahmed I, Challapalli A, Hoskin P. Long-term outcomes from a multicentre study of HDR monotherapy with a single fraction of 19 Gy for localized prostate cancer. Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology. 2026 Mar;216:111385. Epub 2026/01/21.