Abstract
Purpose
This study aims to evaluate the outcomes and toxicities in patients with palpable
local recurrence of prostate cancer after radical prostatectomy (RP), who were treated
with salvage high dose-rate brachytherapy (HDR-BT) with or without pelvic external
beam radiotherapy (EBRT).
Methods
This retrospective review included patients with palpable local recurrence of prostate
cancer after RP who underwent salvage HDR-BT at a single institution between 2002
and 2020. HDR-BT regimens included 950 cGy x 2 (N = 4) or 1500 cGy x 1 (N = 2) combined
with EBRT; or monotherapy with 950 cGy x 4 (N = 1) or 800 cGy x 2 (N = 1). Toxicity
was graded according to CTCAE Version 5.0.
Results
A total of 8 patients were included. Median follow-up was 49 months (range: 9–223
months). Median age at time of salvage brachytherapy was 68 years (range: 59–85 years).
Seven out of 8 patients were alive at last follow-up. There have been no locoregional
recurrences. Three patients developed distant metastatic disease. One patient developed
acute grade 3 urinary obstruction requiring catheterization, which lasted for 1 day
postbrachytherapy. One patient developed late grade 3 urinary incontinence 18 months
after brachytherapy. There were no other grade 2+ toxicities.
Conclusions
This study demonstrates the safety and efficacy of salvage HDR-BT in the setting of
palpable local recurrence of prostate cancer after RP, with durable locoregional control
and acceptable rates of toxicity. HDR-BT should be further explored as an option for
dose-escalated salvage radiotherapy after prior radical prostatectomy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to BrachytherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics.Cancer J Clin. 2021; 71 (2021): 7-33https://doi.org/10.3322/caac.21654
- Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO guideline.J Urol. 2013; 190: 441-449https://doi.org/10.1016/j.juro.2013.05.032
- Natural history of progression after PSA elevation following radical prostatectomy.JAMA. 1999; 281: 1591-1597https://doi.org/10.1001/jama.281.17.1591
- The value of serum prostate specific antigen determinations before and after radical prostatectomy.J Urol. 1989; 141: 873-879https://doi.org/10.1016/S0022-5347(17)41037-8
- Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer.J Urol. 2000; 163: 845-850https://doi.org/10.1016/S0022-5347(05)67817-2
- Adjuvant and salvage radiotherapy after prostatectomy: ASTRO/AUA guideline amendment 2018-2019.J Urol. 2019; 202: 533-538https://doi.org/10.1097/JU.0000000000000295
- The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial.Lancet. 2022; 399: 1886-1901https://doi.org/10.1016/S0140-6736(21)01790-6
- Rates of rectal toxicity in patients treated with high dose rate brachytherapy as monotherapy compared to dose-escalated external beam radiation therapy for localized prostate cancer.Radiother Oncol. 2020; 147: 123-129https://doi.org/10.1016/j.radonc.2020.03.033
- Pelvic complications after prostate cancer radiation therapy and their management: An International Collaborative Narrative Review.Eur Urol. 2019; 75: 464-476https://doi.org/10.1016/j.eururo.2018.12.003
- High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds.J Urol. 2004; 171: 1098-1104https://doi.org/10.1097/01.ju.0000113299.34404.22
- High-dose-rate monotherapy for localized prostate cancer: 10-year results.Int J Radiat Oncol*Biol*Phys. 2016; 94: 667-674https://doi.org/10.1016/j.ijrobp.2015.07.2290
- Prostate high dose-rate brachytherapy as monotherapy for low and intermediate risk prostate cancer: efficacy results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy.Radiother Oncol. 2020; 146: 90-96https://doi.org/10.1016/j.radonc.2020.02.009
- AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options.Journal of Urology. Accessed. March 14, 2022; (|)
- Clinically localized prostate cancer: AUA/ASTRO/SUO Guideline. Part II: recommended approaches and details of specific care options.J Urol. 2018; 199: 990-997https://doi.org/10.1016/j.juro.2018.01.002
- Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer.Radiother Oncol. 2012; 103: 217-222https://doi.org/10.1016/j.radonc.2012.01.007
- Radiation dose escalation or longer androgen suppression to prevent distant progression in men with locally advanced prostate cancer: 10-year data from the TROG 03.04 RADAR trial.Int J Radiat Oncol Biol Phys. 2020; 106: 693-702https://doi.org/10.1016/j.ijrobp.2019.11.415
- Long-term results of NRG oncology/RTOG 0321: a phase II trial of combined high dose rate brachytherapy and external beam radiation therapy for adenocarcinoma of the prostate.Int J Radiat Oncol*Biol*Phys. 2021; 110: 700-707https://doi.org/10.1016/j.ijrobp.2020.11.008
- Salvage high-dose-rate brachytherapy for histologically confirmed macroscopic local relapsed prostate cancer after radical prostatectomy.J Contemp Brachyther. 2016; 8: 477-483https://doi.org/10.5114/jcb.2016.64441
- Salvage radiotherapy for palpable, locally recurrent prostate cancer after radical prostatectomy.Int J Radiat Oncol Biol Phys. 2004; 58: 1530-1535https://doi.org/10.1016/j.ijrobp.2003.09.082
- High-dose-rate brachytherapy with or without intensity modulated radiation therapy as salvage treatment for an isolated, gross local recurrence of prostate cancer post-prostatectomy.Brachytherapy. 2014; 13: 123-127https://doi.org/10.1016/j.brachy.2013.09.008
- Variation in the Definition of Biochemical Recurrence in Patients Treated for Localized Prostate Cancer: The American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel Report and Recommendations for a Standard in the Reporting of Surgical Outcomes.J Urol. 2007; 177: 540-545https://doi.org/10.1016/j.juro.2006.10.097
- Patient- and treatment-specific predictors of genitourinary function after high-dose-rate monotherapy for favorable prostate cancer.Brachytherapy. 2015; 14: 795-800https://doi.org/10.1016/j.brachy.2015.06.004
- Single-fraction brachytherapy as monotherapy for early-stage prostate cancer: The UCSF experience.Brachytherapy. 2019; 18: 470-476https://doi.org/10.1016/j.brachy.2019.03.002
- Adjuvant radiotherapy versus early salvage radiotherapy following radical prostatectomy (TROG 08.03/ANZUP RAVES): a randomised, controlled, phase 3, non-inferiority trial.Lancet Oncol. 2020; 21: 1331-1340https://doi.org/10.1016/S1470-2045(20)30456-3
- Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial.Lancet. 2020; 0https://doi.org/10.1016/S0140-6736(20)31553-1
- Adjuvant radiotherapy versus early salvage radiotherapy plus short-term androgen deprivation therapy in men with localised prostate cancer after radical prostatectomy (GETUG-AFU 17): a randomised, phase 3 trial.Lancet Oncol. 2020; 21: 1341-1352https://doi.org/10.1016/S1470-2045(20)30454-X
- Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data.Lancet. 2020; 396: 1422-1431https://doi.org/10.1016/S0140-6736(20)31952-8
- Salvage radiotherapy for macroscopic local recurrence following radical prostatectomy.Front Oncol. 2021; 11669261https://doi.org/10.3389/fonc.2021.669261
- Feasibility and outcome of PSMA-PET-based dose-escalated salvage radiotherapy versus conventional salvage radiotherapy for patients with recurrent prostate cancer.Front Oncol. 2021; 11715020https://doi.org/10.3389/fonc.2021.715020
- Feasibility and preliminary outcome of salvage combined HDR brachytherapy and external beam radiotherapy (EBRT) for local recurrences after radical prostatectomy.Brachytherapy. 2005; 4: 141-145https://doi.org/10.1016/j.brachy.2004.12.004
- 18F-fluciclovine-PET/CT imaging versus conventional imaging alone to guide postprostatectomy salvage radiotherapy for prostate cancer (EMPIRE-1): a single centre, open-label, phase 2/3 randomised controlled trial.Lancet. 2021; 397: 1895-1904https://doi.org/10.1016/S0140-6736(21)00581-X
- Assessment of 68Ga-PSMA-11 PET accuracy in localizing recurrent prostate cancer: a prospective single-arm clinical trial.JAMA Oncol. 2019; 5: 856-863https://doi.org/10.1001/jamaoncol.2019.0096
- Location of recurrence by Gallium-68 PSMA-11 PET scan in prostate cancer patients eligible for salvage radiotherapy.Urology. 2019; 129: 165-171https://doi.org/10.1016/j.urology.2018.12.055
- Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy.J Clin Oncol. 2007; 25: 2035-2041https://doi.org/10.1200/JCO.2006.08.9607
- The timing of salvage radiotherapy after radical prostatectomy: a systematic review.Int J Radiat Oncol*Biol*Phys. 2012; 84: 104-111https://doi.org/10.1016/j.ijrobp.2011.10.069
Article info
Publication history
Published online: January 07, 2023
Accepted:
December 7,
2022
Received in revised form:
October 10,
2022
Received:
July 12,
2022
Publication stage
In Press Corrected ProofFootnotes
Disclosures: One author received payment for consulting work from Boston Scientific. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
