Magnetic resonance image‐guided salvage brachytherapy after radiation in select men who initially presented with favorable‐risk prostate cancer

Abstract

BACKGROUND. The authors prospectively evaluated the late gastrointestinal (GI) and genitourinary (GU) toxicity and prostate‐specific antigen (PSA) control of magnetic resonance imaging (MRI)‐guided brachytherapy used as salvage for radiation therapy (RT) failure. METHODS. From October 2000 to October 2005, 25 men with a rising PSA level and biopsy‐proven, intraprostatic cancer at least 2 years after initial RT (external beam in 13 men and brachytherapy in 12 men) who had favorable clinical features (Gleason score ≤7, PSA < 10 ng/mL, negative pelvic and bone imaging studies), received MRI‐guided salvage brachytherapy to a minimum peripheral dose of 137 gray on a phase 1/2 protocol. Estimates of toxicity and cancer control were calculated using the Kaplan‐Meier method. RESULTS. The median follow‐up was 47 months. The 4‐year estimate of grade 3 or 4 GI or GU toxicity was 30%, and 13% of patients required a colostomy and/or urostomy to repair a fistula. An interval < 4.5 years between RT courses was associated with both outcomes with a hazard ratio of 12 (95% confidence interval [95% CI], 1.4–100; P = .02) for grade 3 or 4 toxicity and 25 (95% CI, 1.1–529; P = .04) for colostomy and/orurostomy. PSA control (nadir +2 definition) was 70% at 4 years. CONCLUSIONS. The current results indicated that MRI‐guided salvage brachytherapy in men who are selected based on presenting characteristics and postfailure PSA kinetics can achieve high PSA control rates, although complications requiring surgical intervention may occur in 10% to 15% of patients. Prospective randomized studies are needed to characterize the relative cancer control and toxicity after all forms of salvage local therapy. Cancer 2007. © 2007 American Cancer Society.

Salvage ¹²⁵I Seed Implantation for Prostate Cancer with Postradiation Local Recurrence

“…Our prescribed dose was 144 Gy for 125 I, relatively higher than in previously reported cases [4,8,9,10,11,12,13]. All cases showed a decrease in PSA level.…”

“…Several reports have examined salvage brachytherapy [4,8,9,10,11,12,13]. Techniques for salvage low-dose-rate (LDR) brachytherapy after primary radiation failures have changed dramatically over the past 15 years, thanks to improvements in transrectal ultrasonography, the transperineal approach, and dosimetry using improved imaging devices and computer software.…”

Multivariable model development and internal validation for prostate cancer specific survival and overall survival after whole-gland salvage Iodine-125 prostate brachytherapy

“…Other series have provided risk factors for biochemical failure with small groups of whole-gland salvage LDR I-125/Pd-103 and HDR Ir-192-brachytherapy patients and even focal salvage approaches (directed locally at the recurrence) [10][11][12][13][24][25][26][27][28][29][30] . Only a few of the whole-gland salvage brachytherapy studies provide multivariable modelling, with often limited events, categorisation of predictor variables and insufficient description of handling missing data, leading to imprecise estimates [11][12][13]26 .…”

Three-dimensional Elastic Image Registration Based on Strain Energy Minimization: Application to Prostate Magnetic Resonance Imaging

“…[1][2][3][4] Magnetic resonance imaging in conjunction with endorectal coil and MR spectroscopy (MRS) has been shown to further improve the sensitivity and specificity of cancer detection, providing high-quality images with nearly a tenfold signal-to-noise improvement over body phased-array coils. [5][6][7] Although rigid endorectal probes are available, the most popular endorectal probe uses a balloon.…”