Salvage brachytherapy in prostate local recurrence after radiation therapy: predicting factors for control and toxicity

Radiation Oncology

Alfredo Polo³  Alejandro Tormo⁵  Rafael Martínez-Monge⁴  Oscar Abuchaibe⁶  Cristina Gutierrez¹  Joan Pera¹  Benjamin Guix⁷  Asunción Hervás³  Gemma Sancho²  Iván Henríquez⁷ 

[1] Department of Radiation Oncology, Brachytherapy Unit, Institut Catalâ d’Oncologia, Barcelona, Spain;Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;Department of Radiation Oncology, Brachytherapy Unit, Hospital Ramón y Cajal, Madrid, Spain;Department of Radiation Oncology, University Clinic of Navarra, CUN, Pamplona, Spain;Department of Radiation Oncology, University Hospital Politècnic La Fe, Valencia, Spain;Department of Radiation Oncology, Virgilio Galvis Ramirez Cancer Centre, Bucaramanga, Colombia;Department of Radiation Oncology, Radiation Oncology Medical Institute, IMOR, Barcelona, Spain

关键词: Androgen deprivation therapy;    Low-dose-rate-brachytherapy;    High-dose-rate-brachytherapy;    Prostate cancer;    Salvage brachytherapy;   

Others  :  805426
DOI  :  10.1186/1748-717X-9-102

 received in 2013-09-13, accepted in 2014-04-15,  发布年份 2014

【 摘 要 】

Purpose

To evaluate efficacy and toxicity after salvage brachytherapy (BT) in prostate local recurrence after radiation therapy.

Methods and materials

Between 1993 and 2007, we retrospectively analyzed 56 consecutively patients (pts) undergoing salvage brachytherapy. After local biopsy-proven recurrence, pts received 145 Gy LDR-BT (37 pts, 66%) or HDR-BT (19 pts, 34%) in different dose levels according to biological equivalent doses (BED_{2 Gy}). By the time of salvage BT, only 15 pts (27%) received ADT. Univariate and multivariate analyses were performed to identify predictors of biochemical control and toxicities. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were graded using Common Terminology Criteria for Adverse Events (CTCv3.0).

Results

Median follow-up after salvage BT was 48 months. The 5-year FFbF was 77%. HDR and LDR late grade 3 GU toxicities were observed in 21% and 24%. Late grade 3 GI toxicities were observed in 2% (HDR) and 2.7% (LDR). On univariate analysis, pre-salvage prostate-specific antigen (PSA) > 10 ng/ml (p = 0.004), interval to relapse after initial treatment < 24 months (p = 0.004) and salvage HDR-BT doses BED_{2 Gy} level < 227 Gy (p = 0.012) were significant in predicting biochemical failure. On Cox multivariate analysis, pre-salvage PSA, and time to relapse were significant in predicting biochemical failure.

HDR-BT BED_{2 Gy} (α/β 1.5 Gy) levels ≥ 227 (p = 0.013), and ADT (p = 0.049) were significant in predicting grade ≥ 2 urinary toxicity.

Conclusions

Prostate BT is an effective salvage modality in some selected prostate local recurrence patients after radiation therapy. Even, we provide some potential predictors of biochemical control and toxicity for prostate salvage BT, further investigation is recommended.

【 授权许可】

   
2014 Henríquez et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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