PURPOSE: We report the toxicity and biochemical tumor control outcome of a prospective Phase II study using high-dose-rate brachytherapy (HDR) alone as a salvage therapy for recurrent disease after external beam radiotherapy (EBRT).
METHODS: Forty-two patients with biopsy-proven recurrence were enrolled on a Phase II study of salvage HDR monotherapy using iridium-192. Median pretreatment EBRT dose was 8100 cGy (6840-8640 cGy) and the median time from completion of EBRT to salvage HDR was 73 months. The protocol prescription dose of 3200 cGy was delivered in four fractions over 30 hours in a single insertion. Median followup after salvage HDR was 36 months (6-67 months).
RESULTS: The actuarial prostate-specific antigen biochemical relapse-free survival and distant metastases-free survival rates at 5 years were 68.5% and 81.5%, respectively. Cause-specific survival was 90.3%. Late genitourinary Grade 1and 2 toxicities were found in 38% and 48%, respectively, and one patient developed Grade 3 urinary incontinence. Late Grade 1 and 2 gastrointestinal toxicity was noted in 17% and 8% of patients, respectively. Three patients (7%) developed Grade 2 late urinary toxicity (urethral stricture), which were corrected with urethral dilatation, and one patient developed Grade 3 urinary incontinence. No Grade 4 toxicities were observed.
CONCLUSIONS: Genitourinary toxicity was the most commonly encountered toxicity observed after salvage HDR but severe toxicities were uncommon. Salvage HDR is an effective and well-tolerated modality for locally recurrent prostate cancer and should be considered even for patients who have previously been treated with ultra-high dose levels of EBRT.
Written by:
Yamada Y1, Kollmeier MA2, Pei X2, Kan CC2, Cohen GN3, Donat SM4, Cox BW2, Zelefsky MJ2 Are you the author?
1Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: . 2Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY. 3Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY. 4Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY.
Reference: Brachytherapy. 2013 Dec 24 (Epub ahead of print)
doi: 10.1016/j.brachy.2013.11.005
PubMed Abstract
PMID: 24373762
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