Abstract
PurposeTo evaluate efficacy and toxicity after salvage brachytherapy (BT) in prostate local recurrence after radiation therapy.Methods and materialsBetween 1993 and 2007, we retrospectively analyzed 56 consecutively patients (pts) undergoing salvage brachytherapy. After local biopsy-proven recurrence, pts received 145 Gy LDR-BT (37 pts, 66%) or HDR-BT (19 pts, 34%) in different dose levels according to biological equivalent doses (BED2 Gy). By the time of salvage BT, only 15 pts (27%) received ADT. Univariate and multivariate analyses were performed to identify predictors of biochemical control and toxicities. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were graded using Common Terminology Criteria for Adverse Events (CTCv3.0).ResultsMedian follow-up after salvage BT was 48 months. The 5-year FFbF was 77%. HDR and LDR late grade 3 GU toxicities were observed in 21% and 24%. Late grade 3 GI toxicities were observed in 2% (HDR) and 2.7% (LDR). On univariate analysis, pre-salvage prostate-specific antigen (PSA) > 10 ng/ml (p = 0.004), interval to relapse after initial treatment < 24 months (p = 0.004) and salvage HDR-BT doses BED2 Gy level < 227 Gy (p = 0.012) were significant in predicting biochemical failure. On Cox multivariate analysis, pre-salvage PSA, and time to relapse were significant in predicting biochemical failure.HDR-BT BED2 Gy (α/β 1.5 Gy) levels ≥ 227 (p = 0.013), and ADT (p = 0.049) were significant in predicting grade ≥ 2 urinary toxicity.ConclusionsProstate BT is an effective salvage modality in some selected prostate local recurrence patients after radiation therapy. Even, we provide some potential predictors of biochemical control and toxicity for prostate salvage BT, further investigation is recommended.
Highlights
Patients with intermediate or high risk localized prostate cancer treated with standard dose radiation therapy with or without Androgen deprivation therapy (ADT) have a 10 year-rate of biochemical failure (BF) that ranges from 30% to 70%
We provide some potential predictors of biochemical control and toxicity for prostate salvage BT, further investigation is recommended
Patients with intermediate or high risk localized prostate cancer treated with standard dose radiation therapy with or without ADT have a 10 year-rate of biochemical failure (BF) that ranges from 30% to 70%
Summary
Patients with intermediate or high risk localized prostate cancer treated with standard dose radiation therapy with or without ADT have a 10 year-rate of biochemical failure (BF) that ranges from 30% to 70%. Some of these patients will die of prostate cancer [1]. The role of ADT in combination with salvage BT in prostate local recurrence is uncertain because the different studies available comprise a limited and inhomogeneous patient sample [5,6,8,9,10,11,13]
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