Determining the safety of ultrafocal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer: A toxicity assessment of 150 patients

Abstract

Highlights Severe toxicity is as low as 3% (GU), 0% (GI) and 15% (ED). Lower impact is predicted for patients with favorable function at baseline. Lower dose to the urethra (D10% <17 Gy) may prevent urinary symptoms.

Acute toxicity outcomes from salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after prior radiotherapy

“…The readily available nature and reasonable side effect profile to these medication classes suggest that sHDR-BT acute complications may be easily managed. Our study also shows comparable acute GI results to studies in the literature, as seen in Table 7 [14][15][16][34][35][36][37][38][39][40][41][42][43][44][45][46]. Ménard et al [11] used MRI-only or MRI-TRUS guidance sHDR-BT, and reported similar toxicity outcomes.…”

Focal therapy for (recurrent) prostate cancer

“…However the timing of initiation, type of androgen blockade and its role in asymptomatic stages remains poorly defined. ADT has a temporary suppressive effect on the disease, halting its progression for a mean of 2-3 years before the tumor becomes hormone-resistant (66). It is therefore a palliative treatment with no potential of cure.…”

“…Furthermore, delayed tumor regression may cause false positives. Biopsies should therefore not be taken before 24 months of follow-up [66]. Even after two years, routine post-radiotherapy biopsies are of limited added value to regular PSA-testing, and should only be considered in case of biochemical failure [67].…”

“…In the primary whole-gland treatment setting, a prospective randomized controlled trial comparing two fractions of 13.5 Gy to a single dose of 19 Gy HDR-brachytherapy revealed a clear 5-year biochemical disease-free survival advantage in the two-fraction arm (95% versus 73.5%) (61). In the focal salvage treatment setting, the evidence is limited to individual cohort studies which show higher estimated 3-year biochemical disease-free survival among multi-fraction studies (±60% versus ±44%), with comparable toxicity rates (62)(63)(64)(65)(66). Although these results support the use of fractionated treatment, selection bias may affect this interpretation.…”