Salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after primary radiotherapy failure

Wojcieszek, Piotr; Szlag, Marta; Głowacki, Grzegorz; Cholewka, Agnieszka; Gawkowska-Suwińska, Marzena; Kellas-Ślęczka, Sylwia; Białas, Brygida; Fijałkowski, Marek

doi:10.1016/j.radonc.2016.04.032

Cited by 52 publications

(33 citation statements)

References 39 publications

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“…Available data on salvage re-irradiation with HDRB are sparse and were mainly limited by their heterogeneity for both the type of patients included and the radiation protocols used [13–16, 26]. Furthermore, they were often conducted on small cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…Whole prostate gland cryosurgery and low-dose-rate brachytherapy with seeds have similar survival rates with HDRB, but are associated with poorer functional outcomes [28, 30]. Indeed, the most recently published protocols of HDRB were associated with a grade 3 urinary complication rate between 2 and 20%, with almost none severe digestive complications [13, 15–17, 26]. With a bNED rate of 50% after 22.5 months of median follow-up and very low severe toxicity rates, our results on salvage HDRB are very encouraging and are comparable to published data.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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BackgroundOptimal management of locally recurrent prostate cancer after definitive radiation therapy is still challenging. With the development of highly accurate radiotherapy devices, prostate salvage re-irradiation might generate lower toxicity rates than classical salvage therapies. We retrospectively evaluated the toxicity and the feasibility of a prostate re-irradiation after definitive radiation therapy failure. Two modalities were investigated: high-dose-rate brachytherapy (HDRB) on whole prostate gland and focal stereotactic radiotherapy (SBRT) using CyberKnife® linac.MethodsBetween 2011 and 2015, 28 patients with imaged and/or biopsy-proven intra-prostatic recurrence of cancer after definitive radiation therapy underwent a salvage re-irradiation using HDRB (n = 10) or focal SBRT (n = 18). The schedule of re-irradiation was 35 Gy in 5 fractions.Biological response (defined as post-salvage radiation PSA variation) and biochemical no-evidence of disease (bNED) were evaluated in the whole cohort. For patients who had a positive biological response after salvage radiation, biochemical recurrence (BCR) and survival after salvage radiotherapy were evaluated. Post-salvage toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.03 and were compared to baseline status.ResultsWithin a median follow-up of 22.5 months (IQR = 8–42), 9 (90%) patients experienced a positive biological response after salvage HDRB and 5 (50%) remained bNED at the end of the follow-up. Among patients who initially responded to salvage HDRB, the BCR rate was 44.4% after a median interval of 19.5 months (IQR = 11.5–26). Only one patient experienced a transient grade 3 urinary complication.In the SBRT group, the median follow-up was 14.5 months (IQR = 7–23) and 10 (55.6%) out of the 18 patients remained bNED. Among the 15 patients who initially responded to salvage SBRT, 5 (33.3%) experienced a BCR. One patient experienced a transient grade 4 urinary complication.At the end of the follow-up, all evaluated patients had a urinary status grade variation ≤ +1 grade. No grade 3–4 digestive toxicity was observed.ConclusionsSalvage prostate re-irradiation for locally recurrent cancer is feasible and generate low toxicities rates when using with HDRB or focal SBRT. However, further investigations are necessary to confirm these findings and to determine predictive features for patients who might benefit from such an approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Yamada and colleagues reported a disease-free survival of 69% in 42 patients treated to 32 Gy in 4 fractions ( 75 ). Wojcieszek and colleagues reported a 67% disease-free survival among 83 patients treated to 30 Gy in 3 fractions ( 76 ). Jiang and colleagues also used a dose of 30 Gy in 3 fractions, reporting a 5-year disease-free survival of 45% in 22 patients ( 77 ).…”

Section: Rationalementioning

confidence: 99%

High dose-rate brachytherapy in the treatment of prostate cancer

Mendez

Morton

2018

Transl. Androl. Urol.

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High dose-rate (HDR) brachytherapy involves delivery of a high dose of radiation to the cancer with great sparing of surrounding organs at risk. Prostate cancer is thought to be particularly sensitive to radiation delivered at high dose-rate or at high dose per fraction. The rapid delivery and high conformality of dose results in lower toxicity than that seen with low dose-rate (LDR) implants. HDR combined with external beam radiotherapy results in higher cancer control rate than external beam only, and should be offered to eligible high and intermediate risk patients. While a variety of dose and fractionations have been used, a single 15 Gy HDR combined with 40–50 Gy external beam radiotherapy results in a disease-free survival of over 90% for intermediate risk and 80% for high risk. HDR monotherapy in two or more fractions (e.g., 27 Gy in 2 fractions or 34.5 Gy in 3) is emerging as a viable alternative to LDR brachytherapy for low and low-intermediate risk patients, and has less toxicity. The role of single fraction monotherapy to a dose of 19–20 Gy is evolving, with some conflicting data to date. HDR should also be considered as a salvage approach for recurrent disease following previous external beam radiotherapy. A particular advantage of HDR in this setting is the ease of delivering focal treatments, which combined with modern imaging allows focal dose escalation with minimal toxicity. Trans-rectal ultrasound (TRUS) based planning is replacing CT-based planning as the technique of choice as it minimizes or eliminates the need to move the patient between insertion, planning and treatment delivery, thus ensuring high accuracy and reproducibility of treatment.

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“…At a median follow-up of 3 years, the 5-year BRFS and DMFS were 69% and 82% for 42 patients. Other fractionation schedules are 36 Gy in 6 fractions with two implants 1 week apart ( 63 , 92 ); as well as 10 Gy per fraction ×3 fractions with weekly implants ( 95 - 97 ). If multiple fractions are delivered per implant, a minimal interval of 6 hours between fractions is recommended.…”

Section: Adtmentioning

confidence: 99%

“…Wojcieszek et al assessed 83 patients treated with 10 Gy ×3, once every 2 weeks to a total dose of 30 Gy. At a median follow-up of 41 months, the 5-year BRFS was 67% ( 95 ). Jiang et al achieved 5-year biochemical control of 45% for 29 patients Treated with 3 weekly fractions of 10 Gy to the peripheral zone and PET positive area ( 97 ).…”

Section: Adtmentioning

confidence: 99%

The role of salvage brachytherapy for local relapse after external beam radiotherapy for prostate cancer

Tisseverasinghe

Crook

2018

Transl. Androl. Urol.

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Prostate cancer is the most prevalent cancer amongst men. For localized disease, there currently exist several reliable treatment modalities including surgery, radiotherapy and brachytherapy. Our growing understanding of this disease indicates that local control plays a very important role in prevention of subsequent dissemination. Many improvements to external beam radiotherapy over recent years have decreased toxicity and improved outcomes, but nonetheless, local relapse remains common. Many salvage options exist for locally recurrent prostate cancer, but are rarely offered, partly because of the fear of toxicity. Many men with isolated local recurrence therefore do not receive potentially curative second line treatment and are instead treated with palliative androgen suppression. Selection plays an important role in determining which individuals are likely to benefit from salvage. Those at high risk of pre-existing micro-metastatic disease despite negative staging scans are unlikely to benefit. Prostate brachytherapy has evolved over the more than 3 decades of experience. Modern techniques allow more precise tumor localization and dose delivery. Better understanding of dosimetric parameters can distinguish optimal from suboptimal implants. Salvage brachytherapy can be an effective treatment for locally recurrent prostate cancer after prior external beam radiotherapy. We review the literature pertaining to both low dose rate (LDR) and high dose rate (HDR) salvage brachytherapy and discuss patient selection, optimal dose, treatment volume and toxicity avoidance.

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Salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after primary radiotherapy failure

Cited by 52 publications

References 39 publications

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

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

High dose-rate brachytherapy in the treatment of prostate cancer

The role of salvage brachytherapy for local relapse after external beam radiotherapy for prostate cancer

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