Long-term outcomes of salvage transurethral high-dose-rate brachytherapy combined with external beam radiation therapy for anastomotic recurrence of prostate cancer after radical prostatectomy: A retrospective analysis

• Published in: Brachytherapy Vol. 23; no. 2; pp. 179 - 187
• Main Authors: Watanabe, Kenta, Kamitani, Nobuhiko, Ikeda, Naoki, Kawata, Yujiro, Tokiya, Ryoji, Hayashi, Takafumi, Miyaji, Yoshiyuki, Tamada, Tsutomu, Katsui, Kuniaki
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024
• Subjects: Adolescent; Anastomotic recurrence; Brachytherapy - methods; Child; Child, Preschool; Hematology, Oncology, and Palliative Medicine; High-dose-rate brachytherapy; Humans; Male; Neoplasm Recurrence, Local - pathology; Prostate cancer; Prostatectomy; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiology; Radiotherapy Dosage; Retrospective Studies; Salvage Therapy; BED; CSS; GI; OS; iPSA; MRI; HDR-BT; bFFF; GS; Anastomotic recurrence; Salvage therapy; GU; BCR; CT; HIFU; High-dose-rate brachytherapy; Prostate cancer; EBRT; PSA; Gleason score; genitourinary; magnetic resonance imaging; High-intensity focused ultrasound; initial prostate-specific antigen; overall survival; biochemical freedom from failure; computed tomography; cause-specific survival; biochemical recurrence; gastrointestinal; external beam radiation therapy; biological equivalent dose; prostate-specific antigen
• ISSN: 1538-4721; 1873-1449; 1873-1449
• DOI: 10.1016/j.brachy.2023.12.004

High-dose-rate brachytherapy (HDR-BT) delivers high-dose radiation to local lesions within a short treatment period. There are no reports of salvage transurethral HDR-BT for biochemical recurrence (BCR) after radical prostatectomy. Thus, we aimed to evaluate the usefulness of salvage transurethral HDR-BT with external beam radiation therapy (EBRT) for anastomotic prostate cancer recurrence. Patients with postoperative prostate cancer who underwent salvage transurethral HDR-BT with EBRT for anastomotic recurrence at our hospital between January 2002 and July 2009 were retrospectively evaluated. The Kaplan–Meier method was used to estimate biochemical freedom from failure (bFFF), cause-specific survival (CSS), and overall survival (OS) rates. Nine patients were included in this study. The median follow-up period and age were 13.1 (range 4.3–18.4) years and 67 (range 63–78) years, respectively. The dose of HDR-BT ranged from 13 to 24 Gy per 2 to 5 fractions, while that of EBRT ranged from 30 to 44 Gy per 15 to 22 fractions. The 1-year, 5-year, and 10-year bFFF rates were 77.8%, 41.7%, and 13.9%, respectively. The 10-year and 15-year CSS rates were 100% each. The 10-year and 15-year OS rates were 100% and 64.3%, respectively. Six patients were diagnosed with BCR. Two patients experienced Grade 3 hematuria as a late adverse event. There was no exacerbation of urinary incontinence. No prostate cancer-related deaths were observed, even after a long-term follow-up. Salvage transurethral HDR-BT after radical prostatectomy is safe and feasible and may be a useful treatment option.