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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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1/2021
vol. 13
 
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abstract:
Original paper

Salvage brachytherapy for locally recurrent prostate cancer after single-fraction 19 Gy high-dose-rate brachytherapy: toxicity, prostate-specific antigen kinetics, and cancer control

Esther Mayrata
1
,
Jose Maria Espinosa
2
,
David Büchser
1
,
Francisco Casquero
1
,
Fernan Suárez
1
,
Alba González
1
,
Pablo Minguez
2
,
Jose Fernando Pérez
2
,
Iñigo San Miguel
1
,
Jon Cacicedo
1
,
Alfonso Gómez-Iturriaga
1

  1. Radiation Oncology, Cruces University Hospital/Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
  2. Department of Radiation Physics, Cruces University Hospital, Barakaldo, Spain
J Contemp Brachytherapy 2021; 13, 1: 12–17
DOI: https://doi.org/10.5114/jcb.2021.103581
Online publish date: 2021/02/18
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Introduction
To evaluate toxicity, prostate-specific antigen (PSA) kinetics, and cancer control of high-dose-rate brachytherapy (HDR-BT) as a salvage modality for men with locally recurrent prostate cancer, after primary HDR-BT failure.

Material and methods
Twelve patients with biochemical failure and a local relapse after 19 Gy single-fraction high-dose-rate brachytherapy (HDR-BT 19 Gy) were salvaged using two HDR-BT fractions. Salvage treatment consisted of two HDR-BT applications, one week apart, delivering 12 Gy to the prostate per application (HDR-BT 12 × 2).

Results
Median age and initial PSA prior to rescue treatment were 74 years (range, 65-80) and 5.29 ng/ml (range, 2.37-16.40), respectively. Forty-two percent had a low-risk and 58% presented with intermediate-risk prostate cancer. Median follow-up period was 26 months (range, 10-42). Median time to PSA nadir was 12 months, with a median value of 0.21 ng/ml. Most of the patients (11 of 12) achieved a PSA decline ≥ 90%. Acute grade 2 genitourinary (GU) toxicity occurred in 4 patients (33.3%) and none presented with acute gastrointestinal (GI) toxicity. Two patients (16.7%) suffered from late GU grade 2 toxicity. No grade 3 toxicity were recorded. To date, 2 patients (16.7%) have experienced biochemical failure after salvage treatment.

Conclusions
Salvage HDR-BT 12 × 2 is a feasible and well-tolerated treatment, with acceptable toxicity rates for men with locally recurrent prostate cancer, who failed after HDR-BT with 19 Gy. Moreover, PSA kinetics and cancer control after salvage treatment suggest that this strategy might be efficacious in this clinical setting.

keywords:

prostate cancer, salvage brachytherapy, high-dose-rate brachytherapy, recurrent prostate cancer

  
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