23). Mark et al. (46) reported Autophagy inhibitor order in abstract form the results of 301 patients with T1–2, Gleason 4–10, median PSA 9.3 (2.7–39.8) treated with HDR monotherapy. They administered 7.5 Gy in six fractions in two implants performed 1 month apart. Urethral dose points [12], [13], [14], [15] and [16] limited to <105% of the prescription dose. Acute urinary retention occurred in 5%. Late Radiation Therapy Oncology Group (RTOG) urinary toxicity was 3% Grade 2 and Grade 3–4 (urethral stricture requiring dilation 6%). Late RTOG rectal

toxicity was Grade 1–2 (2.3%) and Grade 3–4 (0.3%). The PSA progression–free survival was 88% at 8 years. Rogers et al. (47) reported their experience on 284 patients with intermediate-risk group patients treated with two HDR implants to deliver six fractions of 6.5 Gy. The 5-year

actuarial biochemical survival was 94.4%, local control and cause-specific survival 100%, and distant metastasis–free survival 99%. Percent of core positive over 75% and Stage T2c predicted for worse biochemical control. Patients without these adverse risk factors had a 5-year biochemical control of 97.5%. The incidence of side effects was low. Unlike other reports, there were no urethral strictures. Transient Grade 1 incontinence was found in 7.7% of cases after treatment, but exclusive of patients with prior transurethral resection or neurologic illness it was 2.5%. Grade 1 RTOG rectal toxicity occurred in 4.2%. Potency was maintained in 83% of patients all 2 years after therapy. this website Ghadjar et al. (48) reported on 36 patients with low- (28) and intermediate- (8) risk prostate cancer treated with HDR monotherapy in a single implant and four fractions of 9.5 Gy over 2 days. Acute Grade 3 GU toxicity rate was 3% and late GU toxicity 11%. There was no Grade 3 GI toxicity. The 3-year PSA progression–free survival rate was 100%. The sexual preservation rate in patients without ADT was 75%. Late Grade 3 GU toxicity was associated

with higher PTV doses as represented by the V100 (percent target coverage by 100% isodose) and D90 (dose to 90% of the PTV), and the urethral V120 (volume urethra receiving ≥120% of the prescription dose). Hoskin et al. (49), in the United Kingdom, conducted a dose escalation trial for mostly intermediate- (52%) and high-risk (44%) patients. A total of 197 patients were treated with 34 Gy in four fractions, 36 Gy in four fractions, 31.5 Gy in three fractions, or 26 Gy in two fractions. Median followup times were 60, 54, 36, and 6 months. Incidence of early Grade ≥3 GU morbidity was 3–7%, and Grade 4 0–4%. Grade 3 or 4 early GI morbidity was not observed. Late GU toxicity (3 year actuarial) Grade 3 was 3–16%. The 4-year stricture (requiring surgery) rate was 3–7%. Late GI toxicity Grade 3 was 1%. There was no late Grade 4 GI or GU toxicity. At 3 years, 99% of patients with intermediate-risk and 91% with high-risk disease were free of biochemical relapse (p = 0.02).

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