Salvage Low Dose Rate Brachytherapy For Recurrent Prostate Cancer After External Beam Radiotherapy: Results From A Single Institution With Focus On Toxicity And Functional Outcomes

Abstract

Background/aim:Low dose rate brachytherapy has been used as salvage therapy for locally recurrent prostate cancer (PC) after primary external beam radiation therapy (EBRT), along with surgery and cryotherapy. All these techniques, in particular, when applied to the whole gland, involve a relatively high risk of toxicity and may worsen the patient’s quality of life. Our aim is to evaluate the results of whole-gland salvage brachytherapy (SBT) after primary EBRT in terms of toxicity, functional outcomes, and efficacy.Materials and methods:We retrospectively reviewed clinical data on 19 patients consecutively treated with SBT at our institution between June 2012 and November 2015. Local recurrences were identified with 11C-choline positron emission tomography/computed tomography and pelvic magnetic resonance imaging after biochemical recurrence according to Phoenix criteria (prostate-specific antigen nadir + 2). Low dose rate brachytherapy was performed by 125I permanent seeds implantation to the whole prostate gland, with a prescription dose of 130 Gy. At the time of SBT, only 2 patients were receiving androgen deprivation therapy. Acute and late toxicities were recorded using the CTCAE 4.0 scoring system. Quality of life was assessed using IPSS (International Prostate Symptoms Score) and IIEF (International Index of Erectile Function) questionnaires at baseline and 6, 12, and 24 months after SBT, and the respective mean values were compared using Student t test. Biochemical relapse-free survival (BRFS) was also calculated.Results:Median follow-up after SBT was 24 months. Of 19 patients, 2 patients experienced a G3 cystitis (10.2%) and 1 patient experienced a G4 proctitis (5.3%), respectively. Mean pre-SBT IPSS scores and 6, 12, and 24 months after SBT were 5.84, 10.22, 15.72, and 8.10, respectively. Mean pre-SBT IIEF scores and 6, 12, and 24 months after SBT were 8.42, 3.55, 7.89, and 6.40, respectively. At the time of analysis, only 2 patients showed a biochemical relapse (3-year BRFS 85.2%). The Student t test demonstrated a worsening of functional outcome 6 months and 1 year after treatment but a subsequent improvement 2 years after SBT.Conclusions:Salvage brachytherapy for recurrent PC after primary EBRT seems to be a feasible treatment for selected patients. Our series revealed a severe toxicity peak 6 months and 1 year after local re-treatment and then they decrease. Early BRFS rates are good. However, these are very preliminary results so further patient accrual, long-term follow-up, and prospective trials are needed in the future.

Current state of interventional radiotherapy (brachytherapy) education in Italy: results of the INTERACTS survey

“…The use of interventional radiotherapy (BT) has increased in the last decades, most probably due to technical improvements, allowing to deliver higher doses to the target while reducing dose and volume of organs at risk [ 9 ]. Moreover, BT in Italy has been increasingly based on a multidisciplinary approach, with a growing number of high-quality publications of excellent treatment results [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. These innovations, in the context of a rapid diffusion of 3D planning, with an increased use of computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and ultrasound, favored the diffusion of image-guided brachytherapy (IGBT) [ 32 ] with related clinical benefits.…”

Salvage CyberKnife-Based Reirradiation of Patients With Recurrent Prostate Cancer: The Single-Center Experience

“…When we take into account radical salvage modalities, surgery seems to be the treatment of choice and for a considerable length of time was the only option. [1][2][3][4][5][6] Later on, some new possibilities such as cryotherapy, 7,8 high-intensity focused ultrasound (HIFU), 9,10 and brachytherapy (BT) [11][12][13][14][15][16][17][18] appeared. All the aforementioned modalities have yielded promising results but not consistently-primarily due to limited availability, patient performance status and/or comorbidities, local anatomical conditions, and a lack of patient agreement.…”

Health-related quality of life after ultrafocal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer: reporting the patient’s perspective

“…Two studies reported IPSS and IIEF scores after whole-gland salvage treatments, namely whole-gland salvage LDR-BT (n = 19) and whole-gland salvage HIFU (n = 81). The questionnaires revealed a peak to moderate urinary symptoms (mean IPSS ±15) and a deterioration to severe ED (mean IIEF ±6) in the first year [15] , [16] . Another study on whole-gland salvage HIFU in 61 patients used the University of California Los Angeles Prostate Cancer Index (UCLA-PCI) as patient-reported outcome measurement.…”