Abstract
Purpose
To evaluate the role of salvage prostate brachytherapy for locally recurrent prostate
cancer after external beam radiation alone.
Methods and Materials
Sixty-nine consecutive patients treated with salvage brachytherapy after a local failure
were analyzed. All patients were found to have pathologic proven recurrent prostate
cancer at least 2 years after initial therapy and no regional or distant disease on
imaging studies. Pd-103 was used with a prescribed pD90 of 100 Gy. In total, 89.9% of patients received androgen suppression (AS) as part
of their salvage therapy. Patients whose prostate-specific antigen >5.0 ng/mL while
on AS were considered to have castration resistant prostate cancer (CRPC). Patients
on AS >6 months before salvage brachytherapy were considered to have delayed therapy.
Patients retreated within 5 years after their initial treatment were considered to
have early failures.
Results
Total median followup after salvage therapy was 5.0 years (0.6–13.7). From the date
of salvage, 5-year biochemical control for low-risk patients was 85.6%, intermediate-risk
patients 74.8%, and high-risk patients 66%. Five-year biochemical control was 73.8%
for non-CRPC and 22% for CRPC cases (<0.001). Including and excluding CRPC cases,
early treatment after failure vs. delayed treatment was significantly better (p<0.05). Chronic adverse events were seen in few patients, with genitourinary Grade
3 toxicity of 8.7% and no genitourinary Grade 4 or gastrointestinal Grade 3 or higher
toxicities.
Conclusions
A subset of failures after definitive radiation is local in nature, and excellent
control is possible with salvage brachytherapy.
Keywords
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Article Info
Publication History
Published online: December 02, 2013
Accepted:
October 25,
2013
Received in revised form:
October 17,
2013
Received:
April 11,
2013
Identification
Copyright
© 2014 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
