Protocol-based CT-guided brachytherapy for patients with prostate cancer and previous rectal extirpation-acurative approach.

Abstract

There are numerous curative treatment possibilities for prostate cancer. In patients who have undergone rectal extirpation for rectal cancer treatment, curative options are limited due to anatomic changes and previous irradiation of the pelvis. In this analysis, we validate the feasibility of CT-guided transperineal interstitial brachytherapy for this specific scenario. We analyzed the treatment procedures and outcomes of 5patients with metachronic nonmetastatic prostate cancer. Ultrasound-guided brachytherapy was not possible in any of the patients. Of these 5patients, 3were treated for prostate cancer using temporary brachytherapy with Ir-192 only, and 2were treated with external-beam radiation therapy and temporary brachytherapy as aboost. CT-guided brachytherapy was performed in all patients. We analyzed the feasibility, efficacy, treatment-related toxicity, and quality of life (EORTC-30, IEFF, IPSS, and ICIQ questionnaires) of the treatments. Median follow-up was 35months. Two out of five patients received boost irradiation (HDR 2 × 9Gy, PDR 30 Gy). Three out of five patients were treated with PDR brachytherapy in two sessions up to atotal dose of 60 Gy. Dosimetric parameters were documented as median values as follows: V100 94.7% (94.5-98.4%), D2bladder 64.3% (50.9-78.3%), D10urethra 131.05% (123.2%-141.2%), and D30urethra 122.45% (116.2%-129.5%). At the time of analysis, no biochemical recurrence had been documented. Furthermore, neither early nor late side effects exceeding CTCAE grade2 were documented. CT-guided transperineal brachytherapy of the prostate in patients with previous rectal surgery and radiation therapy is safe and represents apossible curative treatment option. Brachytherapy can be considered for patients with metachronic prostate cancer in this specific scenario, albeit preferably in experienced high-volume centers.