Abstract
Background and purposeLocal re-treatment of radiorecurrent prostate cancer is potentially curative. However, the increased risk of severe toxicity may outweigh the opportunity of cancer control. This study aims to evaluate treatment-related toxicity from ultrafocal salvage high-dose-rate brachytherapy (HDR-BT) and to investigate potential risk factors. Materials and methodsToxicity data from 150 treated patients (July 2013–November 2019) was collected from a prospective registry. The treatment aim was to deliver a single dose of 19 Gy to the recurrent lesion as identified on multiparametric MRI and PET-CT. Treating physicians graded genitourinary (GU) and gastro-intestinal (GI) toxicity and erectile dysfunction (ED) using the Common Terminology Criteria for Adverse Events (CTCAE) 4.0, at baseline and during follow-up. Domains with substantial (≥10%) new-onset grade ≥ 2 toxicity were further evaluated using mixed effects logistic regression to find potential risk factors. ResultsMedian follow-up time was 20 months (IQR 12–31). Over time, new-onset grade 2 and 3 toxicity was recorded in 41% and 3% (GU), 5% and 0% (GI) and 22% and 15% (ED). While GI toxicity remained stably low, grade ≥ 2 GU toxicity and ED were seen twice as frequent in the late phase (>3 months after treatment). Significant risk factors for grade ≥ 2 toxicity were baseline GU toxicity (grade ≥ 2), baseline ED (grade ≥ 2), IPSS (cut-off ≥ 14) and urethral dose (D10%, cut-off ≥ 17 Gy). ConclusionUltrafocal salvage HDR-BT is a safe re-treatment option, especially in patients with a favorable symptom profile at baseline. Adherence to urethral dose constraints is important to avoid GU toxicity.
Highlights
Patients with a local prostate cancer recurrence after radiotherapy are potential candidates for curative salvage treatment, which offers the opportunity to avoid or postpone palliative androgen deprivation therapy (ADT), thereby preventing patients from its associated metabolic, cardiovascular, sexual and psychological side-effects [1,2]
We previously reported tumor control and functional outcomes of 50 patients after two years follow-up [8] and we investigated patient-reported quality of life of 100 patients treated with MRIguided ultrafocal salvage high-dose-rate brachytherapy (HDR-BT) [9]
Baseline GU and GI toxicity was limited to 12% and < 2% grade 2 toxicity, respectively
Summary
Patients with a local prostate cancer recurrence after radiotherapy are potential candidates for curative salvage treatment, which offers the opportunity to avoid or postpone palliative androgen deprivation therapy (ADT), thereby preventing patients from its associated metabolic, cardiovascular, sexual and psychological side-effects [1,2]. Whole-gland salvage treatments are generally associated with (severe) side-effects. A recent prospective study on whole-gland salvage brachytherapy reported 14% grade 3 toxicity [3]. Toxicity from focal salvage treatment seems limited compared to whole-gland salvage treatment, with event rates of severe (grade 3) genitourinary (GU) and gastro-intestinal (GI) toxicity as low as 5% and erectile dysfunction (ED) often reduced, allowing some patients to preserve their potency [5,6,7]. This study aims to evaluate treatment-related toxicity from ultrafocal salvage high-dose-rate brachytherapy (HDRBT) and to investigate potential risk factors. Adherence to urethral dose constraints is important to avoid GU toxicity
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