Between 1998 and 2010, 229 patients with clinically localized, biopsy-proven adenocarcinoma of the prostate were treated with HDR brachytherapy followed 3 weeks later by EBRT at Memorial Sloan-Kettering Cancer Bcl-2 inhibition Center. The clinical characteristics of patients in this study are summarized in Table 1. The patients were stratified into prognostic risk category groups based on the National Comprehensive Cancer Network classification

system (www.nccn.com). This retrospective study was approved by the internal Institutional Review Board. The HDR brachytherapy technique in use at our institution has been described previously (15). In brief, the catheter placement is carried out under general anesthesia using a transperineal approach with a template-based technique using Alectinib solubility dmso real-time transrectal ultrasound guidance. The clinical target volume (CTV) is defined as the prostate gland and the base of seminal vesicles, and the planning target volume is defined as a 3-mm margin around the CTV. Treatment planning for earlier cases in the series was performed using a software package developed at Memorial Sloan-Kettering Cancer Center with the following constraints

relative to the prescription dose: 100% target coverage, 100–120% maximum urethra dose, and rectal maximum dose ≤100% of prescribed dose. Treatment planning for the latter part of the series was done Buspirone HCl using Brachyvision (Varian Medical Systems, Inc., Palo Alto, CA) with similar dose constraints. All patients in this series were treated with 192Ir using GammaMed 12i or aGammaMed Plus remote afterloader (Varian). The first 45 patients were prescribed a peripheral dose of 550 cGy per fraction, the subsequent 40 patients received 600 cGy, the next 32 patients received 650 cGy, the next 108 patients received 700 cGy per fraction (the current dose in use at our institution),

and 4 patients received 750 cGy per fraction. Each patient was treated with HDR brachytherapy delivered in three fractions at least 4 h apart. Patients were typically treated on the day of the implant and subsequent fractions were delivered on the following day with a minimum interfraction interval of 4 h to deliver the total dose within a 24-h time period. Approximately 3 weeks after the HDR procedure, EBRT was initiated using conformal techniques described previously (15). The CTV was defined for this phase of therapy as the prostate gland and seminal vesicles. The planning target volume was defined as a 1-cm margin around the CTV and a 3-mm margin at the prostate rectal interface. The first 11 patients received 4500 cGy in 25 fractions and 1 patient received 4860 cGy; all remaining patients (n = 216) were prescribed 5040 cGy in 28 fractions.