Salvage external beam radiotherapy for locally recurrent prostate cancer after definitive brachytherapy

Abstract Purpose Patients with locally recurrent prostate cancer after definitive prostate brachytherapy have few evidence-based salvage options. We evaluate the efficacy and treatment-related side-effects of salvage external-beam radiotherapy (EBRT) after definitive prostate brachytherapy (PBT). Me...

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Veröffentlicht in:Brachytherapy 2016-11, Vol.15 (6), p.722-729
Hauptverfasser: Rutenberg, Michael S, Meister, Moshe, Amin, Pradip P, Hussain, Arif, Naslund, Michael J, Kwok, Young
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Sprache:eng
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Zusammenfassung:Abstract Purpose Patients with locally recurrent prostate cancer after definitive prostate brachytherapy have few evidence-based salvage options. We evaluate the efficacy and treatment-related side-effects of salvage external-beam radiotherapy (EBRT) after definitive prostate brachytherapy (PBT). Methods and Materials Eleven patients previously treated with definitive PBT and with biopsy-proven local-only recurrence received salvage reirradiation with EBRT. Genitourinary (GU) function was assessed with International Prostate Symptom Scores. Treatment-related toxicities were graded using CTCAE v 4.03. Results Median follow-up was 26.5 months (range, 1–53.6 months); median age at EBRT salvage was 67 years (range, 61–81 years). Salvage EBRT included the whole pelvis in 8 patients. Two patients were treated with 3D-CRT; 9 underwent IMRT. Five patients (45%) received androgen deprivation therapy concurrent with salvage EBRT as part of long- or short-course hormone therapy. The median prostate dose was 70.2 Gy (range, 64.8–75.6 Gy). Actuarial 3-year overall and biochemical failure–free survival were 77% and 69%, respectively. Five patients (45%) had worsening GU symptoms, and 9 (82%) experienced a decline in erectile function. One patient experienced acute grade 2 GU toxicity. Four patients (36%) experienced late grade ≥2 GI/GU toxicities, including 2 who experienced grade 3 toxicities (rectourethral fistula/incontinence, bladder outlet obstruction). No grade 4/5 toxicities were noted. Conclusions Our data suggest that salvage EBRT can provide similar disease control and treatment-related toxicity to more established salvage therapies. This approach warrants further investigation on a larger scale.
ISSN:1538-4721
1873-1449
DOI:10.1016/j.brachy.2016.08.004