{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:32:16Z","timestamp":1785850336920,"version":"3.56.0"},"reference-count":55,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: Combining external beam radiotherapy (EBRT) with high-dose-rate (HDR) brachytherapy (BT) enables biologically effective dose escalation in prostate cancer. However, comparative evaluation of such regimens using radiobiological modeling remains limited. Methods: Dose regimens based on clinical practice were analyzed using \u03b1\/\u03b2 values of 1.5 and 3 Gy for the prostate. Ten patients with available planning CT, pelvic MRI, and ultrasound-guided BT plans were retrospectively evaluated. Physical and biological dose distributions were recalculated for various EBRT and HDR-BT combinations. Biological effective dose (BED) values were determined for the prostate and organs at risk (OARs: anterior rectal wall, bladder base, urethra). Regimens yielding the highest \u0394BED between prostate and OARs were considered most favorable. Results: All regimens met clinical dose constraints. The most favorable \u0394BED profiles for bladder and rectum were observed with HDR-BT regimens (2 \u00d7 15 Gy) combined with either 23 \u00d7 2 Gy or 15 \u00d7 2.5 Gy EBRT, independent of the assumed \u03b1\/\u03b2 value. EBRT-only regimens achieved superior urethral sparing, while higher HDR doses led to increased urethral exposure. Conclusions: This study underscores the value of radiobiological modeling in differentiating and optimizing prostate cancer radiotherapy strategies. While the trade-offs between dose escalation and OAR sparing are clinically known, our biologically driven analysis provides a more quantitative foundation for selecting and tailoring combined EBRT\/HDR-BT regimens in practice.<\/jats:p>","DOI":"10.3390\/curroncol32060360","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T05:08:39Z","timestamp":1750309719000},"page":"360","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dosimetric Comparison of VMAT Alone and VMAT with HDR Brachytherapy Boost Using Clinical and Biological Dose Models in Localized Prostate Cancer"],"prefix":"10.3390","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2599-6196","authenticated-orcid":false,"given":"Manuel","family":"Guhlich","sequence":"first","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Knaus","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Strauss","sequence":"additional","affiliation":[{"name":"Department of Urology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Anna","family":"Fischer","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8826-5662","authenticated-orcid":false,"given":"Jann","family":"Fischer","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Bendrich","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Donath","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5378-4246","authenticated-orcid":false,"given":"Leif Hendrik","family":"Dr\u00f6ge","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3883-6837","authenticated-orcid":false,"given":"Martin","family":"Leu","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Rieken","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7305-9271","authenticated-orcid":false,"given":"Annemarie","family":"Uhlig","sequence":"additional","affiliation":[{"name":"Department of Urology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1375-4496","authenticated-orcid":false,"given":"Markus Anton","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Hille","sequence":"additional","affiliation":[{"name":"Clinic of Radiotherapy and Radiation Oncology, University Medical Center G\u00f6ttingen, Robert-Koch-Str. 40, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21654","article-title":"Cancer Statistics, 2021","volume":"71","author":"Siegel","year":"2021","journal-title":"CA A Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1056\/NEJMoa2214122","article-title":"Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer","volume":"388","author":"Hamdy","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.21873\/invivo.11905","article-title":"BIT-ART: Multicentric Comparison of HDR-brachytherapy, Intensity-modulated Radiotherapy and Tomotherapy for Advanced Radiotherapy in Prostate Cancer","volume":"34","author":"Alitto","year":"2020","journal-title":"In Vivo"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.brachy.2013.05.004","article-title":"Comparison of dose-escalated, image-guided radiotherapy vs. dose-escalated, high-dose-rate brachytherapy boost in a modern cohort of intermediate-risk prostate cancer patients","volume":"13","author":"Marina","year":"2014","journal-title":"Brachytherapy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.clon.2018.05.007","article-title":"Randomised Phase II Feasibility Trial of Image-guided External Beam Radiotherapy With or Without High Dose Rate Brachytherapy Boost in Men with Intermediate-risk Prostate Cancer (CCTG PR15\/ NCT01982786)","volume":"30","author":"Vigneault","year":"2018","journal-title":"Clin. Oncol. (R Coll. Radiol.)"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S0360-3016(03)01456-1","article-title":"Hypofractionation for prostate cancer radiotherapy\u2014What are the issues?","volume":"57","author":"Brenner","year":"2003","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/j.ijrobp.2010.12.040","article-title":"Later outcomes and alpha\/beta estimate from hypofractionated conformal three-dimensional radiotherapy versus standard fractionation for localized prostate cancer","volume":"82","author":"Leborgne","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.clon.2013.05.003","article-title":"Biological dose escalation and hypofractionation: What is there to be gained and how will it best be done?","volume":"25","author":"Tree","year":"2013","journal-title":"Clin. Oncol. (R Coll. Radiol.)"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jamaoncol.2015.2316","article-title":"Dose-Escalated Irradiation and Overall Survival in Men With Nonmetastatic Prostate Cancer","volume":"1","author":"Kalbasi","year":"2015","journal-title":"JAMA Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1200\/JCO.2016.70.4189","article-title":"Moderate Hypofractionation in High-Risk, Organ-Confined Prostate Cancer: Final Results of a Phase III Randomized Trial","volume":"35","author":"Arcangeli","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1200\/JCO.2016.71.7397","article-title":"Randomized Trial of a Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer","volume":"35","author":"Catton","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.clon.2004.12.005","article-title":"The emerging role of high-dose-rate brachytherapy for prostate cancer","volume":"17","author":"Morton","year":"2005","journal-title":"Clin. Oncol. R Coll. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lasorsa, F., Biasatti, A., Orsini, A., Bignante, G., Farah, G.M., Pandolfo, S.D., Lambertini, L., Reddy, D., Damiano, R., and Ditonno, P. (2024). Focal Therapy for Prostate Cancer: Recent Advances and Insights. Curr. Oncol., 32.","DOI":"10.3390\/curroncol32010015"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.radonc.2017.06.012","article-title":"High-dose-rate brachytherapy boost for prostate cancer treatment: Different combinations of hypofractionated regimens and clinical outcomes","volume":"124","author":"Vigneault","year":"2017","journal-title":"Radiother. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.ijrobp.2017.05.013","article-title":"Long-Term Results of a Randomized Trial Comparing Iridium Implant Plus External Beam Radiation Therapy With External Beam Radiation Therapy Alone in Node-Negative Locally Advanced Cancer of the Prostate","volume":"99","author":"Dayes","year":"2017","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.ijrobp.2016.11.026","article-title":"Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (the ASCENDE-RT Trial): An Analysis of Survival Endpoints for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost to a Dose-Escalated External Beam Boost for High- and Intermediate-risk Prostate Cancer","volume":"98","author":"Morris","year":"2017","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"pkaa006","DOI":"10.1093\/jncics\/pkaa006","article-title":"Comparative Effectiveness of Different Radical Radiotherapy Treatment Regimens for Prostate Cancer: A Population-Based Cohort Study","volume":"4","author":"Pettersson","year":"2020","journal-title":"JNCI Cancer Spectr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.radonc.2013.05.002","article-title":"GEC\/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: An update","volume":"107","author":"Hoskin","year":"2013","journal-title":"Radiother. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.ijrobp.2010.03.049","article-title":"70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial","volume":"80","author":"Beckendorf","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e180039","DOI":"10.1001\/jamaoncol.2018.0039","article-title":"Effect of Standard vs Dose-Escalated Radiation Therapy for Patients With Intermediate-Risk Prostate Cancer: The NRG Oncology RTOG 0126 Randomized Clinical Trial","volume":"4","author":"Michalski","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.ijrobp.2019.02.045","article-title":"Dose Escalation for Prostate Adenocarcinoma: A Long-Term Update on the Outcomes of a Phase 3, Single Institution Randomized Clinical Trial","volume":"104","author":"Pasalic","year":"2019","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ijrobp.2010.10.009","article-title":"Comparison of acute and late toxicities for three modern high-dose radiation treatment techniques for localized prostate cancer","volume":"82","author":"Mohammed","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jmir.2012.06.002","article-title":"A Retrospective Planning Analysis Comparing Volumetric-Modulated Arc Therapy (VMAT) to Intensity-Modulated Radiation Therapy (IMRT) for Radiotherapy Treatment of Prostate Cancer","volume":"44","author":"Elith","year":"2013","journal-title":"J. Med. Imaging Radiat. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1200\/JCO.2016.67.0448","article-title":"Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer","volume":"34","author":"Lee","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/S1470-2045(16)30070-5","article-title":"Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): Final efficacy results from a randomised, multicentre, open-label, phase 3 trial","volume":"17","author":"Incrocci","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/S1470-2045(16)30102-4","article-title":"Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial","volume":"17","author":"Dearnaley","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S0140-6736(19)31131-6","article-title":"Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial","volume":"394","author":"Widmark","year":"2019","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1097\/JU.0000000000000071","article-title":"Hypofractionated Radiation Therapy for Localized Prostate Cancer: Executive Summary of an ASTRO, ASCO and AUA Evidence-Based Guideline","volume":"201","author":"Morgan","year":"2019","journal-title":"J. Urol."},{"key":"ref_29","first-page":"100593","article-title":"Comparison of four-year toxicities and local control of ultra-hypofractionated vs moderate-hypofractionated image guided prostate radiation with HDR brachytherapy boost: A phase I-II single institution trial","volume":"40","author":"Beaudry","year":"2023","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13014-021-01976-2","article-title":"Safety of accelerated hypofractionated whole pelvis radiation therapy prior to high dose rate brachytherapy or stereotactic body radiation therapy prostate boost","volume":"17","author":"Phuong","year":"2022","journal-title":"Radiat. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.brachy.2020.02.008","article-title":"A phase IB clinical trial of 15 Gy HDR brachytherapy followed by hypofractionated\/SBRT in the management of intermediate-risk prostate cancer","volume":"19","author":"Den","year":"2020","journal-title":"Brachytherapy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.radonc.2021.05.024","article-title":"Stereotactic pelvic radiotherapy with HDR boost for dose escalation in intermediate and high-risk prostate cancer (SPARE): Efficacy, toxicity and quality of life","volume":"161","author":"Musunuru","year":"2021","journal-title":"Radiother. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.ijrobp.2011.11.047","article-title":"Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer","volume":"84","author":"Zelefsky","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.ijrobp.2019.11.402","article-title":"Standard and Hypofractionated Dose Escalation to Intraprostatic Tumor Nodules in Localized Prostate Cancer: Efficacy and Toxicity in the DELINEATE Trial","volume":"106","author":"Murray","year":"2020","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.brachy.2020.07.011","article-title":"Real-world dosimetric comparison between CyberKnife SBRT and HDR brachytherapy for the treatment of prostate cancer","volume":"20","author":"Chatzikonstantinou","year":"2021","journal-title":"Brachytherapy"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/j.ijrobp.2020.12.041","article-title":"Estimates of Alpha\/Beta (\u03b1\/\u03b2) Ratios for Individual Late Rectal Toxicity Endpoints: An Analysis of the CHHiP Trial","volume":"110","author":"Brand","year":"2021","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.brachy.2020.02.007","article-title":"Evaluation of the urethral \u03b1\/\u03b2 ratio and tissue repair half-time for iodine-125 prostate brachytherapy with or without supplemental external beam radiotherapy","volume":"19","author":"Gocho","year":"2020","journal-title":"Brachytherapy"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.ijrobp.2022.08.030","article-title":"The Fraction Size Sensitivity of Late Genitourinary Toxicity: Analysis of Alpha\/Beta (\u03b1\/\u03b2) Ratios in the CHHiP Trial","volume":"115","author":"Brand","year":"2023","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/S0360-3016(01)02664-5","article-title":"Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha\/beta ratio), similar to late-responding normal tissue","volume":"52","author":"Brenner","year":"2002","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/BF00180606","article-title":"Local staging of prostate carcinoma with endorectal coil MRI: Correlation with whole-mount radical prostatectomy specimens","volume":"6","author":"Bartolozzi","year":"1996","journal-title":"Eur. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1159\/000019816","article-title":"Estimation of prostate cancer volume by endorectal coil magnetic resonance imaging vs. pathologic volume","volume":"35","author":"Ponchietti","year":"1999","journal-title":"Eur. Urol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.2214\/AJR.09.2527","article-title":"Imaging localized prostate cancer: Current approaches and new developments","volume":"192","author":"Turkbey","year":"2009","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.radonc.2008.12.007","article-title":"Association of urethral toxicity with dose exposure in combined high-dose-rate brachytherapy and intensity-modulated radiation therapy in intermediate- and high-risk prostate cancer","volume":"91","author":"Ghadjar","year":"2009","journal-title":"Radiother. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.prro.2013.02.011","article-title":"Dosimetric analysis of radiation therapy oncology group 0321: The importance of urethral dose","volume":"4","author":"Hsu","year":"2014","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.1016\/j.ijrobp.2012.08.037","article-title":"Urethral pain among prostate cancer survivors 1 to 14 years after radiation therapy","volume":"85","author":"Pettersson","year":"2013","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/1748-717X-9-122","article-title":"Late toxicity and five year outcomes after high-dose-rate brachytherapy as a monotherapy for localized prostate cancer","volume":"9","author":"Ghadjar","year":"2014","journal-title":"Radiat. Oncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1007\/s11604-024-01621-4","article-title":"Long-term outcomes of high-dose-rate brachytherapy and external beam radiotherapy without hormone therapy for high-risk localized prostate cancer","volume":"42","author":"Kamitani","year":"2024","journal-title":"Jpn. J. Radiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1016\/j.ijrobp.2023.06.210","article-title":"Long-Term Outcomes of NRG\/RTOG 0126, a Randomized Trial of High Dose (79.2 Gy) vs. Standard Dose (70.2 Gy) Radiation Therapy (RT) for Men with Localized Prostate Cancer","volume":"117","author":"Michalski","year":"2023","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e208221","DOI":"10.1001\/jamanetworkopen.2020.8221","article-title":"Association of the Placement of a Perirectal Hydrogel Spacer With the Clinical Outcomes of Men Receiving Radiotherapy for Prostate Cancer: A Systematic Review and Meta-analysis","volume":"3","author":"Miller","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Kundu, P., Lin, E.Y., Yoon, S.M., Parikh, N.R., Ruan, D., Kishan, A.U., Lee, A., Steinberg, M.L., and Chang, A.J. (2022). Rectal Radiation Dose and Clinical Outcomes in Prostate Cancer Patients Treated With Stereotactic Body Radiation Therapy With and Without Hydrogel. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.853246"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"395","DOI":"10.5301\/tj.5000681","article-title":"Understanding urinary toxicity after radiotherapy for prostate cancer: First steps forward","volume":"103","author":"Rancati","year":"2017","journal-title":"Tumori"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.ejmp.2016.03.003","article-title":"Predicting toxicity in radiotherapy for prostate cancer","volume":"32","author":"Landoni","year":"2016","journal-title":"Phys. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.radonc.2021.12.047","article-title":"GEC-ESTRO ACROP prostate brachytherapy guidelines","volume":"167","author":"Henry","year":"2022","journal-title":"Radiother. Oncol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.radonc.2016.02.004","article-title":"Dose escalation to dominant intraprostatic lesions with MRI-transrectal ultrasound fusion High-Dose-Rate prostate brachytherapy. Prospective phase II trial","volume":"119","author":"Casquero","year":"2016","journal-title":"Radiother. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"508","DOI":"10.3390\/clinpract14020039","article-title":"Tissue-Based Genomic Testing in Prostate Cancer: 10-Year Analysis of National Trends on the Use of Prolaris, Decipher, ProMark, and Oncotype DX","volume":"14","author":"Bologna","year":"2024","journal-title":"Clin. Pract."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/32\/6\/360\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:54:41Z","timestamp":1760032481000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/32\/6\/360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":55,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["curroncol32060360"],"URL":"https:\/\/doi.org\/10.3390\/curroncol32060360","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]}}}