9%) experienced Grade 3 gastrointestinal (GI) toxicity and 15 (8.3%) experienced

Grade HKI-272 research buy ≥3 GU toxicity (21). Notably, this trial required a four-field box technique with margins up to 2 cm on the clinical target volume. Utilization of intensity-modulated radiation therapy, and even image-guided radiotherapy with fiducial marker placement, likely would have reduced the toxicity further. The Cancer and Leukemia Group B 99809 reported their long-term Phase II results from combination brachytherapy and EBRT with the addition of androgen deprivation therapy for intermediate-risk patients (22). With a median followup of over 6 years, the authors reported remarkable low rates of late Grade 3 toxicity (3% [95% confidence interval, 0–8%]). As there continue to be advances in imaging technology, there is a potential for additional improvements in intraoperative treatment planning and

delivery to further improve outcomes. It would be an overstatement Fulvestrant research buy to imply that all intermediate-risk patients require combination therapy. “Intermediate risk” comprises a heterogeneous group of patients with vastly different risks for failure (23). The current National Comprehensive Cancer Network risk grouping does not take into account important prognostic features such as percent positive biopsy cores (9), primary Vasopressin Receptor Gleason pattern (24), or prostate-specific antigen kinetics (25). For this reason, favorable intermediate-risk patients with low volume of disease and few intermediate-risk features may have adequate tumor control with a brachytherapy implant alone. However, patients with bulky disease or Gleason score 4 + 3 are at high risk of recurrence and extraprostatic extension and warrant more aggressive combination

therapy. Ultimately, the resolution of our point counterpoint debate will be addressed when the results of Radiation Therapy Oncology Group 0232 become available in the future. In this trial composed of intermediate-risk men treated with brachytherapy, patients are randomized to the addition of supplemental EBRT. This trial primarily includes favorable intermediate-risk patients and will provide Level 1 evidence to evaluate the effect of increased BED and improved extraprostatic coverage on tumor control prospectively. Until these results are known, the current data support the advantages of supplemental EBRT for intermediate-risk patients. “
“Permanent brachytherapy has become an accepted modality for treating localized prostate cancer. Low-risk disease can be managed with seed implant monotherapy and high-risk disease with a combination of seeds and external beam radiotherapy (EBRT) with or without hormone therapy (HT). Treatment of the intermediate-risk group (IRG) remains controversial.