Scholarly Articles by Dr. Hill
Dr. Hill co-authored an overview article and report on the long-term outcome results of 209 patients treated with HDR brachytherapy and external beam radiation.29 Clinical control, as measured by negative rectal exam and normal PSA was achieved in 90% of cases. The PSA control rates stratified by risk group were 90% for low-risk patients, 87% for intermediate-risk patients.Complication rates were low. There were no rectal complications. There was a 7.7% incidence of urinary complications. The majority were urethral strictures which can be repaired with an office dilation procedure. There were no statistically significant differences in outcome between the low- and intermediate-risk group patients.
Dr. Hill co-authored an article on a total of 411 patients treated with HDR brachytherapy combined with external beam radiation.4 The study compared patients who did or did not receive androgen deprivation therapy (hormone therapy) with the combined treatment. The PSA and clinical control rates after 10 years of follow-up were 92% for the low-risk group, 87% for the intermediate-risk group. There was no difference in outcome identified in patients who received androgen deprivation therapy. The conclusion was that androgen deprivation therapy is not necessary given the high dose to the prostate and surrounding tissue that HDR can deliver.
Dr. Hill co-authored an article on HDR brachytherapy alone without EBRT, also called HDR monotherapy, for low- and intermediate-risk group patients.5 That group was defined as Stage T1 or T2, PSA less than 15 and Gleason score less than or egual to 7. There was clinical control of disease in 96% of cases and a very low complication rate. The conclusion was that HDR monotherapy is equivalent to combined HDR brachytherapy and EBRT for early prostate cancer.
Dr. Hill co-authored an article on HDR monotherapy published in Dec 2011 looking at 298 patients from two institutions treated between 1996 and 2005.30 The 8-year results were 99% local control, 97% biochemical control (nadir +2), 99% distant metastasis–free survival, 99% cause-specific survival, and 95% overall survival. Genitourinary toxicity consisted of 10% transient Grade 2 urinary frequency or urgency and 3% Grade 3 episode of urinary retention. Gastrointestinal toxicity was <1%. The conclusion was that HDR monotherapy is safe and effective treatment for localized prostate cancer.
Other HDR Literature
Results from the literature of HDR brachytherapy in combination with EBRT in patients with low-risk disease show that mean PSA progression-free survival (survival with no clinical, radiological or PSA signs of disease progression) was over 90%, with most patients having five or more years of follow-up 4,7,8,9,10,11,12.
Literature on HDR brachytherapy and EBRT outcomes in patients with intermediate- and high-risk disease based on the length of followup revealed that dosage dramatically affects tumor control. Patients who received the higher doses had an 87% control rate (PSA progression-free survival) compared with 52% in patients who received lower doses. 9,12,14,15
Results of multi-institutional HDR brachytherapy studies confirmed the excellent results across all risk groups, including patients with Gleason grades 8–10.18 These studies were performed to evaluate the benefits of treatment of androgen deprivation (hormone treatment) and radiation of pelvic lymph nodes. Neither a short course (<6 months) of androgen deprivation nor irradiation of pelvic lymph nodes was demonstrated to be of additional benefit.16–18
The results of HDR monotherapy (HDR given without EBRT) for low-risk and intermediate-risk groups were reported by Yoshi 19, Mark 20 and Demanes 21 and range from 86 to 94% disease free survival.
A matched-pair analysis that compared the results of patients who received HDR brachytherapy and EBRT with the results of those who received HDR monotherapy showed that the EBRT was not needed.6 HDR monotherapy was as effective as the combined treatment program. The conclusion was that for early cancer of the prostate HDR monotherapy is effective and ample treatment.