Salvage brachytherapy in prostate local recurrence after radiation therapy: predicting factors for control and toxicity

Abstract

PurposeTo evaluate efficacy and toxicity after salvage brachytherapy (BT) in prostate local recurrence after radiation therapy.Methods and materialsBetween 1993 and 2007, we retrospectively analyzed 56 consecutively patients (pts) undergoing salvage brachytherapy. After local biopsy-proven recurrence, pts received 145 Gy LDR-BT (37 pts, 66%) or HDR-BT (19 pts, 34%) in different dose levels according to biological equivalent doses (BED2 Gy). By the time of salvage BT, only 15 pts (27%) received ADT. Univariate and multivariate analyses were performed to identify predictors of biochemical control and toxicities. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were graded using Common Terminology Criteria for Adverse Events (CTCv3.0).ResultsMedian follow-up after salvage BT was 48 months. The 5-year FFbF was 77%. HDR and LDR late grade 3 GU toxicities were observed in 21% and 24%. Late grade 3 GI toxicities were observed in 2% (HDR) and 2.7% (LDR). On univariate analysis, pre-salvage prostate-specific antigen (PSA) > 10 ng/ml (p = 0.004), interval to relapse after initial treatment < 24 months (p = 0.004) and salvage HDR-BT doses BED2 Gy level < 227 Gy (p = 0.012) were significant in predicting biochemical failure. On Cox multivariate analysis, pre-salvage PSA, and time to relapse were significant in predicting biochemical failure.HDR-BT BED2 Gy (α/β 1.5 Gy) levels ≥ 227 (p = 0.013), and ADT (p = 0.049) were significant in predicting grade ≥ 2 urinary toxicity.ConclusionsProstate BT is an effective salvage modality in some selected prostate local recurrence patients after radiation therapy. Even, we provide some potential predictors of biochemical control and toxicity for prostate salvage BT, further investigation is recommended.

Salvage prostate re-irradiation using high-dose-rate brachytherapy or focal stereotactic body radiotherapy for local recurrence after definitive radiation therapy

“…Prostate re-irradiation was mainly done with low-dose-rate brachytherapy using seeds, with mixed results on efficacy and toxicity [5, 9, 10]. However, recent improvement in radiotherapy devices such as high-dose rate brachytherapy (HDRB) and stereotactic body radiotherapy (SBRT) allow to deliver higher ablative dose in a smaller target volume with better sparing of surrounding critical organs at risk [11, 12].…”

Prognostic correlation of cell cycle progression score and Ki-67 as a predictor of aggressiveness, biochemical failure, and mortality in men with high-risk prostate cancer treated with external beam radiation therapy

“…The ability to predict clinical outcome is essential to implement optimal strategies to treat these patients. 14,15,20,21 In this study, we demonstrate the CCP and Ki-67 derived from the diagnostic biopsy have prognostic clinical information on aggressiveness, BF, OS, and DSM after primary RT. These results are comparable with previous reports on Ki-67 and CCP genes expression studied separately.…”

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 .…”

“…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 . However, there is no data on predictive factors for survival (PCaSS and OS).…”

“…Risk factors for failure and mortality for salvage brachytherapy have not been comprehensively defined, because of small series with often limited events 5,9,10 . A few series have defined pre-salvage PSA, PSA-doubling time (PSADT) and time-to-relapse after primary therapy as possible predictors of biochemical failure after salvage brachytherapy [11][12][13] . Although biochemical failure often precedes the development of distant metastases and death 1 , no predictive factors for survival have as of yet been identified.…”