article · Nigerian Journal of Oncology
A clinical pilot study evaluated the outcomes of adding high-dose rate brachytherapy to external beam radiotherapy for men with intermediate-risk and high-risk localised prostate cancer. Thirty-eight patients were treated across two groups receiving either external beam radiotherapy alone or combined therapy. At twelve months, biochemical-free survival rates were comparable between the two cohorts, standing at roughly 82 percent for radiotherapy alone and 88 percent for the combined approach. All observed biochemical failures occurred in patients with high-risk disease. Patients receiving the brachytherapy boost experienced significantly lower rates of grade one and two late genitourinary side effects compared to those treated with external beam radiotherapy alone. However, measures of late gastrointestinal side effects, general quality of life, and sexual dysfunction showed no statistically significant differences between the two treatment regimens.
Prostate cancer is the most common cancer among Nigerian men. This study provides clinical evidence showing that adding brachytherapy to standard external beam radiotherapy delivers similar early tumour control while significantly reducing urinary complications. Understanding these outcomes helps clinicians make better-informed decisions to minimise adverse treatment effects for patients with localised prostate cancer.
This research provides applied clinical evidence relevant to oncology departments and radiation treatment centres evaluating clinical protocols for localised prostate cancer. While the study tests existing medical equipment and treatment combinations directly on patients, it remains a small pilot study requiring broader validation before informing standardised treatment guidelines or service procurement decisions.
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Background: Prostate cancer is the leading cause of cancer amongst men in Nigeria. External beam radiotherapy (EBRT) and high-dose rate brachytherapy (HDR-BT) play a significant role in the management of localised prostate cancer. Objective: This study compared the treatment outcome of the management of intermediate and high-risk localised prostate cancer patients using EBRT alone and EBRT + BT. Methods: A pilot study was conducted at the University College Hospital, Ibadan, and the Lagos University Teaching Hospital. Thirty-eight (38) patients were recruited, with 19 patients in both EBRT alone and EBRT+BT arms. Biochemical-free survival (BFS), late side effects, and quality of life (QoL) were assessed and compared across both arms. Biochemical free survival was calculated using the Kaplan-Meier survival curve and compared using log log-rank test, quality of life was assessed using the EORTC quality of life questionnaire and mean compared using the t-test. Late side effects were assessed using the RTOG questionnaire and compared using chi-square. Ethical approval was obtained from both institutions. Results: Twenty-seven percent (23%) of the patients recruited had intermediate-risk disease, while seventy-three percent (73%) had high-risk disease, with ADT used before radiotherapy in 71.1%. The mean EQD2 in the EBRT arm and EBRT+BT arm was 63.0Gy and 81.5Gy, respectively. BFS at 12 months was 81.8% and 88.2% for EBRT and EBRT+BT, respectively. Mean time to biochemical recurrence was 11.46 months and 11.82 months for EBRT and EBRT+BT, respectively (p=0.625). All biochemical failures occurred among the high-risk group, with BFS at 12 months being 71.4% and 84.6% for EBRT and EBRT+BT, respectively (p=0.468). Grade 1 and 2 late Genitourinary toxicities were more in the EBRT arm (10.5% and 52.6% respectively) compared to the EBRT+BT arm (5.3% and 15.8% respectively) (P=0.03). Comparison of Gastrointestinal late toxicities, QoL, and sexual function in both arms was not statistically significant. Conclusion: BFS was similar in both treatment arms; however, the EBRT+BT arm had fewer genitourinary side effects than the EBRT arm. Gastrointestinal toxicities, QoL, and sexual dysfunction had comparative incidence in both arms.
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DOI: 10.67579/njo.2025.bfjzda3v
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