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

Abstract

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.

Multiparametric MRI Tumor Probability Model for the Detection of Locally Recurrent Prostate Cancer After Radiation Therapy: Pathologic Validation and Comparison With Manual Tumor Delineations

“…Doses for LDR brachytherapy range from 120 to 145 Gy for 125 I and 90 to 113 Gy for 103 Pd. 28 The 3-level risk map derived from our MRI-based voxel-wise TP model could be used to target the different regions with varying doses. Based on salvage LDR brachytherapy studies 7,29,30 the GTV could be prescribed to a dose of 144 Gy, and the high-risk CTV could function as a margin around the GTV for decreasing treatment dose, while ensuring the CTV would receive a dose of 108 Gy.…”

SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis

“…Although late grade 3 rectal toxicity is rare following definitive upfront brachytherapy, well below 5% in most series, dosimetric rectal outcome has been shown to be overall improved with HDR compared to EBRT [24]. In instances of salvage brachytherapy following biochemical failure post-EBRT, a higher incidence of grade 2/3 rectal toxicity has been reported in low-dose-rate (LDR) and HDR series [25]. When considering upfront treatments in the recent ASCENDE-RT trial, addition of brachytherapy boost to 78 Gy EBRT demonstrated an increase in grade 3 rectal toxicity from 3.2% to 8.1% [26].…”

Salvage high-dose-rate brachytherapy for recurrent prostate cancer

“…В качестве возможных опций для лечения локального рецидива РПЖ выбирают спасительную простатэктомию, спасительную лучевую терапию, гормональную терапию или спасительную высокомощностную брахитерапию (СВБТ) с источником 192 Ir [5][6][7].…”

“…Основные публикации в мире по СВБТ принадлежат небольшому числу авторов и представлены в табл. 1 [5,[8][9][10][11].…”

“…В перечень обследования в обязательном Таблица 1. Международный опыт выполнения спасительной высокомощностной брахитерапии [5,[8][9][10][11] Пациенты с рецидивом РПЖ были разделены на 3 группы в зависимости от вида первоначального радикального лечения: РПЭ, ДЛТ и брахитерапии (табл. 2).…”