Long-term results of a protocol-based ultrasound-guided salvage brachytherapy as re-irradiation for local recurrent prostate cancer

• Published in: Radiotherapy and oncology 2020-09, Vol.150, p.201-205
• Main Authors: Schönle, Nicole, Strnad, Vratislav, Lotter, Michael, Kreppner, Stephan, Fietkau, Rainer
• Format: Article
• Language: English
• Subjects: Aged; Brachytherapy - adverse effects; Humans; Male; Neoplasm Recurrence, Local - radiotherapy; Prostate cancer; Prostatic Neoplasms - radiotherapy; Radiotherapy Dosage; Re-Irradiation; Salvage Therapy; Salvage-brachytherapy; Ultrasonography, Interventional
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2020.06.031

•Local recurrent prostate cancer.•Re-irradiation.•Tumor control.•Salvage brachytherapy.•Late side effects. To assess the long-term results of protocol-based ultrasound-guided salvage pulsed-dose rate brachytherapy in locally recurrent prostate cancer following previous radiation therapy. A total of 82 patients (median age 69 years) with locally recurrent prostate cancer after previous external beam radiation therapy (43/82, 52.4%), prostatectomy and adjuvant radiation therapy (24/82, 29.3%) or brachytherapy (15/82, 18.3%) were treated with sole salvage interstitial pulsed-dose rate brachytherapy (PDR-BT). The treatment regimen consisted of two PDR-BT sections with 30 Gy (single pulse dose 0.6 Gy/h, 24 h per day) each up to a total reference dose of 60 Gy (EQD2 = 71.5 Gy-eq). The endpoints of the present analysis are cumulative local recurrence-rate, PSA-free survival, overall survival and the treatment-associated late toxicity according to the “Common Toxicity Criteria” with a median follow-up of 49 months (range, 12–129 months). The 5-y. overall cumulative local recurrence rate was 17.7% with no significant differences between low, intermediate and high-risk groups. Differences in PSA-free survival were marginally non-significant, at 67.3%, 70.4% and 63.8% for low, intermediate and high risk group, respectively. No grade 3 gastrointestinal late side effects have been observed. The most common late side effect was urinary incontinence grade 1–3 and urinary frequency/urgency grade 1–3 in 18.3% (15/82) and 17.1% (14/82) of patients, respectively. PDR salvage brachytherapy in local recurrent previously irradiated prostate cancer is efficient with low late toxicity. Salvage-brachytherapy represents a valuable therapeutic option for the treatment of previously irradiated locally recurrent prostate cancer.