Reinforcing the benefit of brachytherapy in prostate cancer and the evolving role of brachytherapy in the management of early penile cancer

16-17 November 2023, Prague, Czech Republic

The 2023 Groupe Européen de Curiethérapie (GEC)-ESTRO workshop welcomed delegates to the wonderful city of Prague in November, where delegates had ample opportunity over two days to network, to learn about ongoing projects from the GEC-ESTRO working groups and to expand their knowledge regarding the latest developments in the field of brachytherapy.

Professor Peter Hoskin (Mount Vernon Cancer Centre, UK) chaired the urology group (UroGEC) lectures, the focus of which was on the well-established and expanding evidence base for the use of brachytherapy to treat prostate cancer and the lesser-known indications for its application in penile cancer.

The first talk was delivered by Dr Imtiaz Ahmed (Southend University Hospital, UK) on the use of high-dose-rate monotherapy to treat localised prostate cancer. He offered his perspective on single-fraction treatment rather than the standard two-fraction approach. He recognised the current evidence base¹ that supports two-fraction treatment as superior in terms of cancer control after five years, but he suggested single-fraction treatment as a viable alternative, especially for those men who wished to avoid treatment that they saw as burdensome, due to their age or comorbidities. In particular, such treatment of men with low-risk or favourable intermediate-risk prostate cancer demonstrated high levels of cancer control, with five-year biochemical-relapse-free survival rates of 100% and 92% respectively². For those who showed less favourable risk characteristics, relapse rates were higher, supporting the two-fraction approach as the gold-standard treatment.

The second talk of the afternoon was delivered by Dr Piotr Lelek (Maria Sklodowska-Curie National Research Institute of Oncology, Poland) on the important role of brachytherapy in the treatment of penile cancer. Surgical treatment of this cancer is life-changing, both physically and psychologically, and therefore a penis-preserving approach is always considered. Brachytherapy offers an alternative treatment approach for localised disease, with good oncological outcomes and penile preservation; however, there is no consensus on the cases for which it should be considered and its use is under-represented in current clinical guidelines. Work is ongoing to establish consensus guidelines for the management of penile cancer and the hope is that brachytherapy will be embedded within treatment decision-making pathways for cases in which it can be used.

Dr Oliver Coen

speciality registrar in clinical oncology

Leeds Cancer Centre, UK

oliver.coen@nhs.net

References

1. Morton G, McGuffin M, Chung HT, et al. Prostate high dose-rate brachytherapy as monotherapy for low and intermediate-risk prostate cancer: Efficacy results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy. Radiother Oncol. 2020 May;146:90-96. doi: 10.1016/j.radonc.2020.02.009.
2. Ahmed I, Sandar Tun K, Shibuthomas S, et al. 5-Year result of single-institute cohort study in single-fraction HDR monotherapy for localised prostate cancer. J Clin Oncol. 2023 41:6_suppl, 362. doi: 10.1200/JCO.2023.41.6_suppl.362