{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:03:16Z","timestamp":1792267396891,"version":"4.4.0"},"reference-count":31,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"24","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2023,8,20]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p>To determine whether addition of external beam radiation therapy (EBRT) to brachytherapy (BT) (COMBO) compared with BT alone would improve 5-year freedom from progression (FFP) in intermediate-risk prostate cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Men with prostate cancer stage cT1c-T2bN0M0, Gleason Score (GS) 2-6 and prostate-specific antigen (PSA) 10-20 or GS 7, and PSA &lt; 10 were eligible. The COMBO arm was EBRT (45 Gy in 25 fractions) to prostate and seminal vesicles followed by BT prostate boost (110 Gy if 125-Iodine, 100 Gy if 103-Pd). BT arm was delivered to prostate only (145 Gy if 125-Iodine, 125 Gy if 103-Pd). The primary end point was FFP: PSA failure (American Society for Therapeutic Radiology and Oncology [ASTRO] or Phoenix definitions), local failure, distant failure, or death.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Five hundred eighty-eight men were randomly assigned; 579 were eligible: 287 and 292 in COMBO and BT arms, respectively. The median age was 67 years; 89.1% had PSA &lt; 10 ng\/mL, 89.1% had GS 7, and 66.7% had T1 disease. There were no differences in FFP. The 5-year FFP-ASTRO was 85.6% (95% CI, 81.4 to 89.7) with COMBO compared with 82.7% (95% CI, 78.3 to 87.1) with BT (odds ratio [OR], 0.80; 95% CI, 0.51 to 1.26; Greenwood T P = .18). The 5-year FFP-Phoenix was 88.0% (95% CI, 84.2 to 91.9) with COMBO compared with 85.5% (95% CI, 81.3 to 89.6) with BT (OR, 0.80; 95% CI, 0.49 to 1.30; Greenwood T P = .19). There were no differences in the rates of genitourinary (GU) or GI acute toxicities. The 5-year cumulative incidence for late GU\/GI grade 2+ toxicity is 42.8% (95% CI, 37.0 to 48.6) for COMBO compared with 25.8% (95% CI, 20.9 to 31.0) for BT ( P &lt; .0001). The 5-year cumulative incidence for late GU\/GI grade 3+ toxicity is 8.2% (95% CI, 5.4 to 11.8) compared with 3.8% (95% CI, 2.0 to 6.5; P = .006).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Compared with BT, COMBO did not improve FFP for prostate cancer but caused greater toxicity. BT alone can be considered as a standard treatment for men with intermediate-risk prostate cancer.<\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.22.01856","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T20:03:11Z","timestamp":1686772991000},"page":"4035-4044","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":39,"title":["Effect of Brachytherapy With External Beam Radiation Therapy Versus Brachytherapy Alone for Intermediate-Risk Prostate Cancer: NRG Oncology RTOG 0232 Randomized Clinical Trial"],"prefix":"10.1200","volume":"41","clinical-trial-number":[{"clinical-trial-number":"nct00063882","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0563-3766","authenticated-orcid":false,"given":"Jeff M.","family":"Michalski","sequence":"first","affiliation":[{"name":"Washington University\u2014Siteman Cancer Center, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"Winter","sequence":"additional","affiliation":[{"name":"NRG Oncology Statistics and Data Management Center\/ACR, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley R.","family":"Prestidge","sequence":"additional","affiliation":[{"name":"Bon Secours DePaul Medical Center, Norfolk, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin G.","family":"Sanda","sequence":"additional","affiliation":[{"name":"Emory University Hospital\/Winship Cancer Institute, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahul","family":"Amin","sequence":"additional","affiliation":[{"name":"University of Tennessee Health Science Center, Memphis, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William S.","family":"Bice","sequence":"additional","affiliation":[{"name":"John Muir Medical Center, Walnut Creek, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiram A.","family":"Gay","sequence":"additional","affiliation":[{"name":"Washington University\u2014Siteman Cancer Center, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3663-2408","authenticated-orcid":false,"given":"Geoffrey S.","family":"Ibbott","sequence":"additional","affiliation":[{"name":"University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0711-3318","authenticated-orcid":false,"given":"Juanita M.","family":"Crook","sequence":"additional","affiliation":[{"name":"BCCA-Cancer Centre for the Southern Interior, Kelowna, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles N.","family":"Catton","sequence":"additional","affiliation":[{"name":"University Health Network-Princess Margaret Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Raben","sequence":"additional","affiliation":[{"name":"Delaware\/Christiana Care NCI Community Oncology Research Program, Newark, DE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7015-7204","authenticated-orcid":false,"given":"Walter","family":"Bosch","sequence":"additional","affiliation":[{"name":"Washington University\u2014Siteman Cancer Center, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Beyer","sequence":"additional","affiliation":[{"name":"Arizona Oncology Services Foundation, Tucson, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6517-7884","authenticated-orcid":false,"given":"Steven J.","family":"Frank","sequence":"additional","affiliation":[{"name":"University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Papagikos","sequence":"additional","affiliation":[{"name":"Novant Health New Hanover Regional Medical Center\u2014Zimmer Cancer Institute, Wilmington, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth A.","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Sutter Cancer Research Consortium, Roseville, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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