Focal partial salvage low-dose-rate brachytherapy for local recurrent prostate cancer after permanent prostate brachytherapy with a review of the literature

Abstract

PurposeTo investigate the treatment results for focal partial salvage re-implantation against local recurrence after permanent prostate brachytherapy.Material and methodsBetween January 2010 and September 2015, 12 patients were treated with focal partial salvage re-implantation for local recurrence after low-dose-rate brachytherapy using 125I seeds. The focal clinical target volume (F-CTV) was delineated on positive biopsy areas in a mapping biopsy, combining the cold spots on the post-implant dosimetry for initial brachytherapy. The F-CTV was expanded by 3 mm to create the planning target volume (PTV) as a margin to compensate for uncertainties in image registration and treatment delivery. The prescribed dose to the PTV was 145 Gy. The characteristics and biochemical disease-free survival (BdFS) rates were analyzed. Genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.ResultsThe median prostate-specific antigen (PSA) level at re-implantation was 4.09 ng/ml (range: 2.91-8.24 ng/ml). The median follow-up time was 56 months (range: 6-74 months). The median RD2cc and UD10 were 63 Gy and 159 Gy, respectively. The 4-year BdFS rate was 78%, which included non-responders. Biochemical recurrence occurred in two patients after 7 and 31 months, respectively. The former was treated with hormonal therapy after biochemical failure, and the latter underwent watchful waiting (PSA at the last follow-up of 53 months: 7.3 ng/ml) at the patient's request. No patients had grade 3 GU/GI toxicities or died after salvage re-implantation.ConclusionsThe partial salvage low-dose-rate brachytherapy used to treat local recurrence after permanent prostate brachytherapy is well-tolerated, with high biochemical response rates. This treatment can be not only a method to delay chemical castration but also a curative treatment option in cases of local recurrence of prostate carcinoma after seed implantation.

Salvage high-dose-rate brachytherapy for histologically confirmed macroscopic local relapsed prostate cancer after radical prostatectomy

“…We observed slightly better outcomes regarding treatment related toxicities than that reported in both EBRT and brachytherapy series [26, 27, 28], which could be explained by the use of the real time MRI/TRUS fusion protocol. All patients in our study showed an appropriate biochemical response; with PSA nadir of 0.73 ng/ml (range: 0.1-3.89 ng/ml) at last follow-up visit, being the median pretreatment PSA 2.71 ng/ml (range: 1.84-13.93 ng/ml).…”

“…Although there are some studies investigating the role of brachytherapy for local recurrences after prostate radiotherapy or brachytherapy [27, 28], very few series have reported results of salvage brachytherapy after radical prostatectomy and the number of patients included is rather small [27, 28, 29, 30, 31, 32, 33, 34, 35, 36]. Table 3 shows a description of these series.…”

Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy

“…These findings highlight the potential utility of mpMRI as a diagnostic strategy to guide biopsy if local salvage options are considered. The increasing interest in the use of focal therapies or focal salvage approaches (23)(24)(25)(26) necessitates a clear understanding of sites of recurrence to maximize efficacy. Further, the patterns of recurrence may have implications for the treatment of patients with brachytherapy.…”

Comparative cost-effectiveness of focal and total salvage 125 I brachytherapy for recurrent prostate cancer after primary radiotherapy

“…Furthermore, focal salvage is still in the experimental phase, as is reflected in the amount of literature available on the subject. This is especially clear in the 125 I brachytherapy setting, in which only four studies so far were published (with 12, 15, 20, and 25 patients, respectively) [17, 19, 31, 32]. The effect of focal salvage regarding biochemical control and prostate cancer specific survival in the long run is still unknown, since multifocal disease might be present at the time of failure and subsequently during salvage treatment.…”