Feasibility of high-dose-rate brachytherapy salvage for local prostate cancer recurrence after radiotherapy: University of California-San Francisco experience

Journal Article · Thu Mar 15 04:00:00 EDT 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.10.012· OSTI ID:20944769

Lee, Brian ^[1]; Shinohara, Katsuto ^[2]; Weinberg, Vivian ^[3]; Gottschalk, Alexander R ^[1]; Pouliot, Jean ^[1]; Roach, Mack ^[1]; Hsu, I -Chow ^[1]

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1. Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA (United States)
2. Department of Urology, University of California-San Francisco, San Francisco, CA (United States)
3. Comprehensive Cancer Center Biostatistics Core, University of California-San Francisco, San Francisco, CA (United States)

Purpose: The aim of this study was to evaluate the feasibility and safety of salvage high-dose-rate (HDR) brachytherapy for locally recurrent prostate cancer after external beam radiotherapy (EBRT). Methods and Materials: We retrospectively analyzed 21 consecutively accrued patients undergoing salvage HDR brachytherapy for locally recurrent prostate cancer after EBRT between November 1998 and December 2005. After pathologic confirmation of locally recurrent disease, all patients were treated with 36 Gy in six fractions using two transrectal ultrasound-guided HDR prostate implants, separated by 1 week. Eleven patients received neoadjuvant hormonal therapy immediately presalvage, whereas none received adjuvant hormonal therapy postsalvage. Median follow-up time from recurrence was 18.7 months (range, 6-84 months). Determination of subsequent biochemical failure after brachytherapy was based on the definition by the American Society for Therapeutic Radiology and Oncology. Results: Based on the Common Terminology Criteria for Adverse Events (CTCAE version 3), 18 patients reported Grade 1 to 2 genitourinary symptoms by 3 months postsalvage. Three patients developed Grade 3 genitourinary toxicity. Maximum observed gastrointestinal toxicity was Grade 2; all cases spontaneously resolved. The 2-year Kaplan-Meier estimate of biochemical control after recurrence was 89%. Thirteen patients have achieved a PSA nadir {<=}0.1 ng/ml, but at the time of writing this endpoint has not yet been reached for all patients. All patients are alive; however 2 have experienced biochemical failure, both with PSA nadirs {>=}1, and have subsequently been found to have distant metastases. Conclusions: Salvage HDR prostate brachytherapy appears to be feasible and effective.

• OSTI ID: 20944769
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 67; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRACHYTHERAPY
CARCINOMAS
DOSE RATES
FAILURES
HORMONES
METASTASES
NEUTRON DIFFRACTION
PATIENTS
PROSTATE
RADIATION SOURCE IMPLANTS
SAFETY
SYMPTOMS
TOXICITY