Salvage external beam radiotherapy for locally recurrent prostate cancer after definitive brachytherapy

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• 作者：Michael S. Rutenberg¹ ; Moshe Meister² ; Pradip P. Amin² ; Arif Hussain³ ; Michael J. Naslund⁴ ; Young Kwok² ; ^{ykwok@umm.edu}
• 关键词：Salvage external beam radiotherapy ; Reirradiation ; Prostate brachytherapy
• 刊名：Brachytherapy
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：15
• 期：6
• 页码：722-729
• 全文大小：314 K
• 卷排序：15

文摘

Patients with locally recurrent prostate cancer after definitive prostate brachytherapy have few evidence-based salvage options. We evaluate the efficacy and treatment-related side-effects of salvage external-beam radiotherapy (EBRT) after definitive prostate brachytherapy (PBT).Methods and MaterialsEleven patients previously treated with definitive PBT and with biopsy-proven local-only recurrence received salvage reirradiation with EBRT. Genitourinary (GU) function was assessed with International Prostate Symptom Scores. Treatment-related toxicities were graded using CTCAE v 4.03.ResultsMedian follow-up was 26.5 months (range, 1–53.6 months); median age at EBRT salvage was 67 years (range, 61–81 years). Salvage EBRT included the whole pelvis in 8 patients. Two patients were treated with 3D-CRT; 9 underwent IMRT. Five patients (45%) received androgen deprivation therapy concurrent with salvage EBRT as part of long- or short-course hormone therapy. The median prostate dose was 70.2 Gy (range, 64.8–75.6 Gy). Actuarial 3-year overall and biochemical failure–free survival were 77% and 69%, respectively. Five patients (45%) had worsening GU symptoms, and 9 (82%) experienced a decline in erectile function. One patient experienced acute grade 2 GU toxicity. Four patients (36%) experienced late grade ≥2 GI/GU toxicities, including 2 who experienced grade 3 toxicities (rectourethral fistula/incontinence, bladder outlet obstruction). No grade 4/5 toxicities were noted.ConclusionsOur data suggest that salvage EBRT can provide similar disease control and treatment-related toxicity to more established salvage therapies. This approach warrants further investigation on a larger scale.