High-dose-rate brachytherapy for localized prostate adenocarcinoma post abdominoperineal resection of the rectum and pelvic irradiation: Technique and experience

Jabbari, Siavash; Hsu, I.-Chow; Kawakami, Jun; Weinberg, Vivian K.; Speight, Joycelyn L.; Gottschalk, Alexander R.; Roach, Mack; Shinohara, Katsuto

doi:10.1016/j.brachy.2009.02.004

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Volume 8, Issue 4 , Pages 339-344, October 2009

High-dose-rate brachytherapy for localized prostate adenocarcinoma post abdominoperineal resection of the rectum and pelvic irradiation: Technique and experience

Siavash Jabbari
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
I.-Chow Hsu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
Jun Kawakami
- Department of Urology, University of California San Francisco, San Francisco, CA
Vivian K. Weinberg
- Department of Biostatistics, University of California San Francisco, San Francisco, CA
Joycelyn L. Speight
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
- Department of Urology, University of California San Francisco, San Francisco, CA
Alexander R. Gottschalk
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
Mack Roach III
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
- Department of Urology, University of California San Francisco, San Francisco, CA
Katsuto Shinohara
- Department of Urology, University of California San Francisco, San Francisco, CA
- Corresponding author. Department of Urology, University of California San Francisco, 1600 Divisadero Avenue, MZ Bldg A, Room A-643, San Francisco, CA 94115. Tel.: +1-415-353-7101; fax: +1-415-353-7443.

Received 21 November 2008; received in revised form 11 February 2009; accepted 13 February 2009. published online 12 May 2009.

Abstract

Purpose

Treatment options are limited for patients with localized prostate cancer and a prior history of abdominoperineal resection (APR) and pelvic irradiation. We have previously reported on the successful utility of high-dose-rate (HDR) brachytherapy salvage for prostate cancer failing definitive external beam radiation therapy (EBRT). In this report, we describe our technique and early experience with definitive HDR brachytherapy in patients post APR and pelvic EBRT.

Patients and Methods

Six men with newly diagnosed localized prostate cancer had a prior history of APR and pelvic EBRT. Sixteen to 18 HDR catheters were placed transperineally under transperineal ultrasound–guidance. The critical first two catheters were placed freehand posterior to the inferior rami on both sides of the bulbar urethra under cystoscopic visualization. A template was used for subsequent catheter placement. Using CT-based planning, 5 men received 36Gy in six fractions as monotherapy. One patient initially treated with EBRT to 30Gy, received 24Gy in four fractions.

Results

Median age was 67.5 (56–74) years. At a median followup of 26 (14–60) months, all patients are alive and with no evidence of disease per the Phoenix definition of biochemical failure, with a median prostate-specific antigen nadir of 0.19ng/mL. Three men have reported grade 2 late genitourinary toxicity. There has been no report of grade 3–5 toxicity.

Conclusion

Transperineal ultrasound–guided HDR brachytherapy using the above technique should be considered as definitive therapy for patients with localized prostate cancer and a prior history of APR and pelvic EBRT.

Keywords: Prostate cancer, Brachytherapy, High-dose-rate, Abdominoperineal resection, HDR