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Clinical Trial
. 2014 Mar-Apr;13(2):111-6.
doi: 10.1016/j.brachy.2013.11.005. Epub 2013 Dec 25.

A Phase II study of salvage high-dose-rate brachytherapy for the treatment of locally recurrent prostate cancer after definitive external beam radiotherapy

Yoshiya Yamada  1 , Marisa A Kollmeier  2 , Xin Pei  2 , Chu Cheng Kan  2 , Gil'ad N Cohen  3 , Sherri M Donat  4 , Brett W Cox  2 , Michael J Zelefsky  2
Affiliations
Clinical Trial

A Phase II study of salvage high-dose-rate brachytherapy for the treatment of locally recurrent prostate cancer after definitive external beam radiotherapy

Yoshiya Yamada et al. Brachytherapy. 2014 Mar-Apr.

Abstract

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.

Keywords: High dose rate brachytherapy; Salvage brachytherapy.

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Figures

Fig. 1
Fig. 1
PSA relapse-free survival. PSA = prostate-specific antigen; HDR = high-dose-rate brachytherapy.
Fig. 2
Fig. 2
Distant metastases-free survival. HDR = high-dose-rate brachytherapy.
Fig. 3
Fig. 3
Grade 2 GI and Grade 2 GU toxicity–free toxicity survival curve. GI =gastrointestinal; GU = genitourinary; HDR = high-dose-rate brachytherapy.
See this image and copyright information in PMC

References

    1. Zelefsky MJ, Yamada Y, Fuks Z, et al. Long-term results of conformal radiotherapy for prostate cancer: Impact of dose escalation on biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys. 2008;71:1028–1033. - PubMed
    1. Sheets NC, Goldin GH, Meyer AM, et al. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA. 2012;307:1611–1620. - PMC - PubMed
    1. Cahlon O, Zelefsky MJ, Shippy A, et al. Ultra-high dose (86.4 Gy) IMRT for localized prostate cancer: Toxicity and biochemical outcomes. Int J Radiat Oncol Biol Phys. 2008;71:330–337. - PubMed
    1. Spratt DE, Pei X, Yamada J, et al. Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2013;85:686–692. - PMC - PubMed
    1. Zelefsky MJ, Pei X, Chou JF, et al. Dose escalation for prostate cancer radiotherapy: Predictors of long-term biochemical tumor control and distant metastases-free survival outcomes. Eur Urol. 2011;60:1133–1139. - PMC - PubMed

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