Systematic Review of Focal Prostate Brachytherapy and the Future Implementation of Image-Guided Prostate HDR Brachytherapy Using MR-Ultrasound Fusion

Table 2

Summary of clinical manuscripts.

Author/; year	Focal/ focused	Tumor/; treatment imaging	Technique (HDR/LDR)	Dosimetry	Symptoms/outcome	Salv.
DiBiase et al. 2002 [20]	Focused	MRI,; Biopsy mapping/MRI	LDR 145 Gy × 1 fx, LR disease, 130% boost to gross tumor	V100 95% (89–98%); DmaxUrethra 160% (range 131–220%); 110% (range 74–150%)	FU duration not recorded, progression not reported; GU toxicity grade I 87%, grade II 53%; No urinary incontinence, no rectal toxicity	No
Hsu et al. 2013 [22]	Focal	MRI, MRS, biopsy mapping/MRI reg US	LDR 144 Gy × 1 fx. Post LDR focal salvage, TRUS confirmed disease, 1-2 foci.	187.5 Gy (107.5–247.5) 99.0% (91.7–100.0) 5.5% (0.1–18.7)	5 y FU, recurrence (Phoenix criteria): 1 y 0%, 2 y 0%, and 3 y 62.7%; Pre-GI grade I, 13.3%, grade II, 6.7%, post-GI grade I, 13.3, grade II, 0%; Pre-GU grade I, 33.3%, grade II, 60.0%, grade III, 6.7%; Post-GI: grade I, 6.7%, grade II, 60.0%, grade III, 33.3%; Pre ED: grade I, 26.7%, grade II, 53.3%, grade III, 0%; Post ED: grade I, 13%, grade II, 66.7%, grade III, 13.3%
Barret et al. 2013 [23]	Focal	biopsy mapping/TRUS	LDR compared to other focal techniques in LR disease	NR	FU to one year, PSA change median 6.2 (5–7.9) baseline to 2.5 (0.9–4.4) at 1 year; Median 3 (1–7), median 7 (2–12); Median 21 (10–25), median 14 (8–24)	NA
Wallace et al. 2013 [24]	Focal	MRI, biopsy mapping/NR	LDR 124 Gy × 1 fx Single patient s/p EBRT 75 Gy for IR disease, Salvage at 4 years	100%,; 100%; 0.00cc; 54.52%	Median FU 1 month, PSA at one year 0.52 and decreasing; Postsalvage: no ED, nocturia 0-1x, 1-2 hr daily voiding; AUA 21 from baseline of 5, SHIM score 22 (No ED); 3 months: GU and GI symptoms back to baseline
Peters et al. 2014 [16]	Focal	MRI/MRI reg US	LDR, LR, IR & HR, 144 Gy × 1 fx focal salvage, 35% post LDR, 65% post EBRT, TRUS confirmed unilateral disease 2 y post RT	198 Gy (150–330); 68 Gy (18–96); 133 Gy (69–207); was 132 Gy (100–240)	Median FU 36 months, recurrence (Phoenix criteria): 15% (3 of 6 no initial response); Presalvage ED: grade II, 50%, grade III, 25%, 3 yr ED: grade II, 35%, grade III, 20%; Presalvage GI grade I, 45%, grade II, 10%, 3 yr GI grade I, 13.3%, grade II, 15%; Presalvage GU grade I, 25%, grade II, 10%, 3 yr GU grade I, 5%, grade II, 15%; Only one patient: grade III toxicity (GU) at 3 years FU
Ennis et al. 2015 [21]	Focused	TTI TRUS/TRUS	LDR Pd-103, prospective IR patients with Gleason ≤ 6. Total prostate treated with dose painting (GTV goal D100 200% and same OAR constraints as typical plan)	Standard whole gland plan: 49%; 1%; 51%; Focused plan: 97%; 11%; 60%	Biological recurrence: 0% at 31.5 months; Acute (less than 6 months), late (greater than 6 months); Acute proctitis grade I, 23%, grade II, 0%, late proctitis grade I, 0%, grade II, 17%; Acute urgency/frequency grade I, 54%, grade II, 46%; Late urgency/frequency grade I, 58%, grade II, 17%; Acute ED: grade I, 31%, grade II, 54%, grade III, 0%; Late ED: grade I 33%, grade II, 42%, grade III, 17%; No grade III toxicity	No

FU: follow-up, GU: genitourinary, GI: gastrointestinal, Salv.: salvageable, LR: low risk, IR: intermediate risk, HR: high risk, reg: registered, ED: erectile dysfunction, NR: not reported, TTI: tissue-type imaging, IPSS: International Prostate Symptom Score, IIEF-5: 5-item version of the International Index of Erectile Function.
Would be salvageable given data if not salvage therapy.
Would not be salvageable given data if not salvage therapy.