PURPOSE: To assess the overall clinical outcome of protocol-based image-guided salvage pulsed-dose-rate brachytherapy for locally recurrent prostate cancer after radiotherapy failure particularly regarding feasibility and side effects. PATIENTS AND METHODS: Eighteen consecutive patients with locally recurrent prostate cancer (median age, 69 years) were treated during 2005-2011 with interstitial PDR brachytherapy (PDR-BT) as salvage brachytherapy after radiotherapy failure. The treatment schedule was PDR-BT two times with 30 Gy (pulse dose 0.6 Gy/h, 24 h per day) corresponding to a total dose of 60 Gy. Dose volume adaptation was performed with the aim of optimal coverage of the whole prostate (V100 > 95 %) simultaneously respecting the protocol-based dose volume constraints for the urethra (D0.1 cc < 130 %) and the rectum (D2 cc < 50-60 %) taking into account the previous radiation therapy. Local relapse after radiotherapy (external beam irradiation, brachytherapy with J-125 seeds or combination) was confirmed mostly via choline-PET and increased PSA levels. The primary endpoint was treatment-related late toxicities--particularly proctitis, anal incontinence, cystitis, urinary incontinence, urinary frequency/urgency, and urinary retention according to the Common Toxicity Criteria. The secondary endpoint was PSA-recurrence-free survival. RESULTS: We registered urinary toxicities only. Grade 2 and grade 3 toxicities were observed in up to 11.1 % (2/18) and 16.7 % (3/18) of patients, respectively. The most frequent late-event grade 3 toxicity was urinary retention in 17 % (3/18) of patients. No late gastrointestinal side effects occurred. The biochemical PSA-recurrence-free survival probability at 3 years was 57.1 %. The overall survival at 3 years was 88.9 %; 22 % (4/18) of patients developed metastases. The median follow-up time for all patients after salvage BT was 21 months (range, 8-77 months). CONCLUSION: Salvage PDR-brachytherapy of the prostate following local failure after radiation therapy is a treatment option with a low rate of genitourinary side effects and no late gastrointestinal side effects. The treatment efficacy in the first 3 years is promising.
PURPOSE: To assess the overall clinical outcome of protocol-based image-guided salvage pulsed-dose-rate brachytherapy for locally recurrent prostate cancer after radiotherapy failure particularly regarding feasibility and side effects. PATIENTS AND METHODS: Eighteen consecutive patients with locally recurrent prostate cancer (median age, 69 years) were treated during 2005-2011 with interstitial PDR brachytherapy (PDR-BT) as salvage brachytherapy after radiotherapy failure. The treatment schedule was PDR-BT two times with 30 Gy (pulse dose 0.6 Gy/h, 24 h per day) corresponding to a total dose of 60 Gy. Dose volume adaptation was performed with the aim of optimal coverage of the whole prostate (V100 > 95 %) simultaneously respecting the protocol-based dose volume constraints for the urethra (D0.1 cc < 130 %) and the rectum (D2 cc < 50-60 %) taking into account the previous radiation therapy. Local relapse after radiotherapy (external beam irradiation, brachytherapy with J-125 seeds or combination) was confirmed mostly via choline-PET and increased PSA levels. The primary endpoint was treatment-related late toxicities--particularly proctitis, anal incontinence, cystitis, urinary incontinence, urinary frequency/urgency, and urinary retention according to the Common Toxicity Criteria. The secondary endpoint was PSA-recurrence-free survival. RESULTS: We registered urinary toxicities only. Grade 2 and grade 3 toxicities were observed in up to 11.1 % (2/18) and 16.7 % (3/18) of patients, respectively. The most frequent late-event grade 3 toxicity was urinary retention in 17 % (3/18) of patients. No late gastrointestinal side effects occurred. The biochemical PSA-recurrence-free survival probability at 3 years was 57.1 %. The overall survival at 3 years was 88.9 %; 22 % (4/18) of patients developed metastases. The median follow-up time for all patients after salvage BT was 21 months (range, 8-77 months). CONCLUSION: Salvage PDR-brachytherapy of the prostate following local failure after radiation therapy is a treatment option with a low rate of genitourinary side effects and no late gastrointestinal side effects. The treatment efficacy in the first 3 years is promising.
Authors: Daher C Chade; Shahrokh F Shariat; Angel M Cronin; Caroline J Savage; R Jeffrey Karnes; Michael L Blute; Alberto Briganti; Francesco Montorsi; Henk G van der Poel; Hendrik Van Poppel; Steven Joniau; Guilherme Godoy; Antonio Hurtado-Coll; Martin E Gleave; Marcos Dall'Oglio; Miguel Srougi; Peter T Scardino; James A Eastham Journal: Eur Urol Date: 2011-03-21 Impact factor: 20.096
Authors: Andrew J Stephenson; Peter T Scardino; Fernando J Bianco; Christopher J DiBlasio; Paul A Fearn; James A Eastham Journal: J Urol Date: 2004-12 Impact factor: 7.450
Authors: G L Grado; J M Collins; J S Kriegshauser; C S Balch; M M Grado; G P Swanson; T R Larson; M M Wilkes; R J Navickis Journal: Urology Date: 1999-01 Impact factor: 2.649
Authors: Piyush K Agarwal; Natalia Sadetsky; Badrinath R Konety; Martin I Resnick; Peter R Carroll Journal: Cancer Date: 2008-01-15 Impact factor: 6.860
Authors: Brian V Balgobind; Kees Koedooder; Diego Ordoñez Zúñiga; Raquel Dávila Fajardo; Coen R N Rasch; Bradley R Pieters Journal: Br J Radiol Date: 2015-08-20 Impact factor: 3.039
Authors: A M Kukiełka; M Hetnał; T Dąbrowski; T Walasek; P Brandys; D Nahajowski; R Kudzia; D Dybek; M Reinfuss Journal: Strahlenther Onkol Date: 2013-12-08 Impact factor: 3.621
Authors: Sebastian Hild; Christian Graeff; Antoni Rucinski; Klemens Zink; Gregor Habl; Marco Durante; Klaus Herfarth; Christoph Bert Journal: Strahlenther Onkol Date: 2015-11-27 Impact factor: 3.621
Authors: Andrzej M Kukiełka; Vratislav Strnad; Paul Stauffer; Tomasz Dąbrowski; Marcin Hetnał; Damian Nahajowski; Tomasz Walasek; Piotr Brandys; Robert Matys Journal: J Contemp Brachytherapy Date: 2015-05-28