Abstract
Purpose
Rates of late toxicity are higher for salvage treatment of local recurrence after
prior radiotherapy. We present our experience with salvage prostate brachytherapy
(BT) for local recurrence after definitive external beam radiotherapy with attention
to the relationship between dose and late toxicity.
Methods and Materials
From 2005 to 2012, 18 patients with biopsy proven locally recurrent prostate cancer
and negative staging received low-dose-rate BT with a prescribed dose of 130–144 Gy.
Toxicities were graded using Common Terminology Criteria for Adverse Events, version
3.0.
Results
Median followup is 31.5 months (range, 12–104). International Prostate Symptom Scores
peaked at 3 months (median, 21/35), returning to baseline by 24 months. Urinary catheterization
rate was 33% (median duration, 14 days; range, 1–90 days). Late Grade 3/4 genitourinary
toxicity occurred in 1 patient each, one of whom also had Grade 3 late gastrointestinal
toxicity; urethral strictures developed in three others. These 5 patients with late
toxicity had higher dose to the prostate (isodose enclosing 90% [D90] median, 151 Gy; range, 135–185 Gy) compared with those without late complications
(median, 134 Gy; range, 105–165; p < 0.04). Acute gastrointestinal toxicity Grade <3 occurred in 44%. Four patients
(22%) experienced biochemical failure.
Conclusion
Salvage low-dose-rate prostate BT can provide durable biochemical control. Care should
be taken to select patients with higher likelihood of organ-confined disease. The
goal of planning should be to treat the recurrent disease to an adequate dose with
careful attention to maintain a conservative D90.
Keywords
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Article info
Publication history
Published online: February 26, 2015
Accepted:
January 19,
2015
Received in revised form:
January 16,
2015
Received:
December 28,
2014
Footnotes
Conflict of interest: None to report.
Identification
Copyright
© 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
