Salvage Brachytherapy with HDR or LDR for Locally Recurrent Prostate Cancer after Primary Permanent Prostate Implantation: UCSF Preliminary Data

High-dose-rate stereotactic body radiation therapy for postradiation therapy locally recurrent prostatic carcinoma: Preliminary prostate-specific antigen response, disease-free survival, and toxicity assessment

“…16 In contradistinction, the University of California San Francisco group did not report any high-grade toxicity in patients with local failure after prior permanent source brachytherapy (both LDR and HDR salvage brachytherapy techniques were used in that series), so this specific topic remains unsettled but is still of a potential cautionary stance. 30 Patients with delayed local recurrence post-conventional external beam RT with or without minor (grade 1) pre-existing complications do not appear to present any prohibitive toxicity risk with salvage SBRT. Still, the sample sizes in this and other published RT salvage modalities are too small to establish which has the higher versus lower relative risk-although at least 1 permanent source brachytherapy salvage series reported a very significant complication rate (30% grade 3-4 GU toxicity and 13% colostomy rates), the majority of which occurred in patients salvaged b 4.5 years after their initial treatment (vs median N 7 years to salvage in the present series).…”

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

“…Other studies have examined mpMRI efficacy after EBRT (19)(20)(21)(22), and observed DCE to be a valuable sequence. Our results suggest that DCE may be easy for radiologists to interpret (81.1% agreement), though its relative low PPV (64.9%) suggests that metallic seed distortion may limit its interpretation.…”

Retreatment for Local Recurrence of Prostatic Carcinoma After Prior Therapeutic Irradiation: Efficacy and Toxicity of HDR-Like SBRT

“…The 60% 5-year bRFS in this series is within the 45% to 78% range of reported 5-year salvage brachytherapy results. 12,[15][16][17][18][27][28][29][30][31][32][33] As previously described in great detail, the dose morphology in this protocol was designed to replicate that of HDR brachytherapy such that brachytherapy equivalence is expected and reasonably demonstrated herein. 19 We also report a biochemical relapse-free efficacy rate that appears at least comparable to that reported with salvage radical prostatectomy (RP); 60% 5-year bRFS in the present series versus 57% 3-year bRFS in a contemporary salvage RP series of similar size and similar median follow-up.…”

“…Limiting the analysis to the much larger subset of "intact prostate postconventional fractionation external-beam RT" relapse salvage cases, the actuarial 5-year rate of grade 3þ GU toxicity is reduced to 3%, which is within the same range as reported with brachytherapy in primary and local recurrence salvage series. 7,[14][15][16][17][28][29][30][31][32][33] Another small HDR salvage series reported an adverse outcome for prior brachytherapy relapse cases; 2 out of 2 salvaged previous brachytherapy cases developed a necrotic urethra. 30 In contrast, the UCSF group did not observe greater high-grade toxicity in the local brachytherapy salvage of prior postbrachytherapy local recurrence.…”

“…30 In contrast, the UCSF group did not observe greater high-grade toxicity in the local brachytherapy salvage of prior postbrachytherapy local recurrence. 31 Thus, this issue is not settled though still of concern. If SBRT salvage of a postbrachytherapy relapse is considered, it would be wise to evaluate the actuarial prior brachytherapy dose summary, with extra caution advised if the relapse occurred in a case that had a high prior prostate D90 or similar "high dose" characteristics.…”