Salvage high‐dose‐rate brachytherapy for local prostate cancer recurrence after radiotherapy – preliminary results

• Published in: BJU international Vol. 109; no. 6; pp. 835 - 839
• Main Authors: Jo, Yoshimasa, Fujii, Tomohiro, Hara, Ryoei, Yokoyama, Teruhiko, Miyaji, Yoshiyuki, Yoden, Eisaku, Hiratsuka, Junichi, Nagai, Atsushi
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; brachytherapy; Brachytherapy - methods; Follow-Up Studies; Gynecology. Andrology. Obstetrics; high dose rate; Humans; Iridium Radioisotopes - therapeutic use; iridium‐192 (Ir192); Male; Male genital diseases; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - radiotherapy; Nephrology. Urinary tract diseases; prostate cancer; Prostatic Neoplasms - radiotherapy; Radiotherapy Dosage; salvage therapy; Salvage Therapy - methods; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; high dose rate; iridium-192 (Ir192); Nephrology; Relapse; Urinary system disease; Prostate disease; Malignant tumor; Radiotherapy; Dose rate; Urology; Iridium; Salvage treatment; brachytherapy; salvage therapy; Male genital diseases; Prostate cancer; Curietherapy; High dose; Cancer
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10519.x

Study Type – Prognostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? There have been no reports on the application of HDR‐BT in Japan as salvage therapy for recurrence following radiotherapy. Our data showed that salvage HDR‐BT is effective as an option for treatment of local prostate cancer recurrence after radiotherapy. OBJECTIVE •  To assess the preliminary clinical results of salvage high‐dose‐rate brachytherapy (HDR‐BT) applied in cases of suspected local recurrence or of residual tumour after radiotherapy. PATIENTS AND METHODS •  The subjects were 11 patients who met the above conditions and underwent salvage HDR‐BT between December 2006 and January 2009. The T stage at the initial treatment was T1c in three patients, T2 in three patients and T3 in five patients. •  Ten patients received HDR‐BT ± electron beam radiation therapy and one patient received proton beam irradiation. •  Follow‐up after the completion of salvage HDR‐BT lasted 18–41 months (mean 29 months). A dose of 11.0 Gy radiation was delivered twice (22.0 Gy in total), separated by a 6‐h interval, on the day the applicators were inserted. RESULTS •  Seven of the 11 cases remained in a biochemical non‐evidence of disease state. •  The prostate‐specific antigen (PSA) level continuously rose after salvage HDR‐BT in three of the four other cases. Hormone administration was initiated in the four cases of PSA recurrence. •  No G3 or more severe events occurred, and the incidence of G2 was low during this study period. CONCLUSION •  Of the 11 cases treated with salvage HDR‐BT, PSA levels remained low in seven cases and the incidence of complications was also low. This suggests that salvage HDR‐BT is effective as an option for treatment of local prostate cancer recurrence after radiotherapy.