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

Abstract

Introduction: Although radiotherapy has been important in the therapy for localized prostate cancer, prostate-specific antigen failure may occur. This study evaluated the effects and side effects of ¹²⁵I low-dose-rate brachytherapy for patients with postradiation local failure. Patients and Methods: 15 patients who received salvage brachytherapy were analyzed. A prescribed dose of 144 Gy was selected. Median follow-up calculated from the date of salvage brachytherapy was 33.0 months (range 6-51). Results: 5 patients (33.3%) developed prostate-specific antigen failure. The biochemical relapse-free survival rate was 100% at 1 year, 91.7% at 2 years, and 60.2% at 3 years. All acute genitourinary and gastrointestinal adverse events were in grade 1-2 according to Common Terminology Criteria for Adverse Events version 3. As for late adverse events, 1 patient (6.7%) developed grade 3 hematuria at 17 months postsalvage. Conclusions: Although careful patient selection is needed, salvage ¹²⁵I prostate brachytherapy appears to provide good prostate cancer control with an acceptable rate of complications for patients with local recurrence of prostate cancer after initial radiotherapy.

Efficacy and toxicity outcomes for patients treated with focal salvage high dose rate brachytherapy for locally recurrent prostate cancer

“…Stratifying patients based on PSA kinetics may help predict the likely response to salvage brachytherapy. The PSA nadir post salvage was identified as a predictor of bPFS in previous studies [8,22,24,32]. This is consistent with the results of our study, where nadir PSA < 0.2 ng/ml was associated with improved bPFS post salvage.…”

Salvage helical tomotherapy for prostate cancer recurrence following definitive external beam radiotherapy: A case report

“…Only one patient experienced grade 3 rectal hemorrhage, while others experienced grade 2 complications that were managed conservatively. A similar study of 15 patients, who underwent brachytherapy for the treatment of recurrence after definitive EBRT, showed a biochemical relapse-free survival rate of 60.2% 3 years after salvage brachytherapy and all acute adverse events were grade 1 or 2 (12). Furthermore, Ramey and Marshall (15) investigated 18 previous studies of salvage brachytherapy and concluded that brachytherapy is a reasonable salvage option for patients with local recurrence after primary EBRT for prostate cancer.…”

“…Salvage re-irradiation for recurrent prostate cancer after primary EBRT has been limited due to toxicity to adjacent organs, particularly the rectum and bladder (10). Although, certain recent studies have reported the effectiveness and safety of re-irradiation with brachytherapy for locally relapsed prostate cancer, reports of re-irradiation using EBRT are scarce (11,12). Thus, in the present study, two cases of locally relapsed prostate cancer following EBRT treated with re-irradiation using helical tomotherapy are discussed.…”

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

“…A recent systematic review by the Reirradiation Study Group of the Italian Association of Radiation Oncology (AIRO) showed that salvage brachytherapy is the most commonly used radiation technique for post-EBRT intraprostatic tumor recurrence [31]. Brachytherapy allows delivery of high doses to the target volume with remarkable OAR sparing in view of a rapid dose fall-off outside the sources, and more and more experiences have been published on this [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51], so that it is recommended by NCCN guidelines, too. Some other reports describe prostate stereotactic Re-I using the Cyber Knife [52][53][54][55][56][57], or external beam Re-I with VMAT [14,15,58,59].…”