Feasibility and preliminary outcome of salvage combined HDR brachytherapy and external beam radiotherapy (EBRT) for local recurrences after radical prostatectomy

Niehoff, Peter; Loch, T.; Nürnberg, N.; Galalae, Razvan; Egberts, Jan Hendrik; Kohr, P.; Kovács, György

doi:10.1016/j.brachy.2004.12.004

Cited by 25 publications

(16 citation statements)

References 25 publications

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“…Niehoff et al . [15] employed a combination of intensity modulated brachytherapy (IMBT) and EBRT in 35 patients with transrectal ultrasound (TRUS)‐visible local recurrence following radical prostatectomy [15]. All patients had a minimum of 5 mm between the tumour and anterior rectal wall and no infiltration of the bladder or the bladder neck.…”

Section: Salvage Brachytherapy After Radical Prostatectomymentioning

confidence: 99%

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Brachytherapy for the treatment of recurrent prostate cancer after radiotherapy or radical prostatectomy

Gómez-Veiga¹,

Mariño²,

Álvarez³

et al. 2012

BJU International

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What's known on the subject? and What does the study add? The curative treatment of prostate cancer includes surgery, external beam radiation or interstitial radiation. However, a high percentage of patients may develop recurrent disease, which is often localised. The possibilities of treatment in these cases, including surgery or adjuvant radiotherapy, are not well defined. Brachytherapy is a well established first-line treatment option. We review and update the use of brachytherapy in the treatment of recurrences post-radiotherapy, brachytherapy or radical prostatectomy as an alternative to surgery and radiotherapy, with a focus on functional and oncological outcomes. Salvage therapeutic options following radical prostatectomy or radiotherapy for patients with local relapse of prostate cancer include radical prostatectomy, radiotherapy, brachytherapy or cryotherapy. Salvage radical prostatectomy following radiotherapy failure is associated with a 5-year PSA relapse-free rate of 30-40%. Biochemical relapse-free survival rates after salvage radiotherapy following radical prostatectomy failure range from 10% to 77% after a follow-up of 22-60 months. A number of studies have evaluated salvage brachytherapy for radiotherapy failure and 5-year biochemical disease-free survival (bDFS) rate results reported are of the order of 20-87%; one study reported a 10-year bDFS rate of 54%. Fewer studies in small numbers of patients and with shorter follow-up have been conducted on brachytherapy for radical prostatectomy failure and bDFS rates reported include 25.8% at a median of 29 months to 70% at a median of 20 months. The side-effects were as expected for brachytherapy. A newer initiative conducted in Spain in a larger series of 42 patients with failure following radical prostatectomy involves brachytherapy with RAPID Strand™(125) I seeds and real-time placement. The 5-year bDFS rate was 88.6% and cancer-specific survival was 97%; complication rates were low. Optimization of salvage brachytherapy is under way and involves accurate placement of seeds, dose optimization and optimal patient selection.

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Section: Salvage Brachytherapy After Radical Prostatectomymentioning

confidence: 99%

“…In the Niehoff study [15], six patients developed Grade I/II dysuria and six Grade I/II lower bowel side‐effects (proctitis and diarrhoea). No Grade III/IV acute side‐effects for lower gastrointestinal (GI) tract or bladder were reported.…”

Section: Salvage Brachytherapy After Radical Prostatectomymentioning

confidence: 99%

Brachytherapy for the treatment of recurrent prostate cancer after radiotherapy or radical prostatectomy

Gómez-Veiga¹,

Mariño²,

Álvarez³

et al. 2012

BJU International

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“…Although there are some studies investigating the role of brachytherapy for local recurrences after prostate radiotherapy or brachytherapy [27, 28], very few series have reported results of salvage brachytherapy after radical prostatectomy and the number of patients included is rather small [27, 28, 29, 30, 31, 32, 33, 34, 35, 36]. Table 3 shows a description of these series.…”

Section: Discussionmentioning

confidence: 99%

“…The largest HDR series published so far, by Niehoff et al . [29], included 35 patients treated with two 15 Gy HDR-BT sessions, 21 patients received complementary 30 Gy EBRT to the small pelvis (four-field box technique), whereas the remaining 14 received 40 Gy. Mean follow-up for each group was 29 and 26 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

Salvage high-dose-rate brachytherapy for histologically confirmed macroscopic local relapsed prostate cancer after radical prostatectomy

Büchser

Gómez-Iturriaga

Melcon

et al. 2016

jcb

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PurposeTo evaluate the feasibility of the use of real-time magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion guided high-dose-rate brachytherapy (HDR-BT) +/– external beam radiation therapy (EBRT) in patients with histologically-proven local relapse after radical prostatectomy.Material and methodsWe retrospectively reviewed 13 patients treated with real-time MRI-TRUS fusion HDR-BT for a local relapse of prostate cancer after radical surgery. All patients underwent multiparametric magnetic resonance imaging (mpMRI) to confirm the presence of macroscopic lesions in prostate bed, and choline positron emission tomography/computed tomography (PET/CT) to rule out nodal or distant metastases. Local failure was confirmed by transrectal biopsy. Patients without previous EBRT received 1 fraction of 15 Gy with HDR-BT plus hypofractionated EBRT (37.5 Gy in 15 fractions). Two patients received 2 fractions of 12 Gy with HDR-BT without EBRT. Follow-up visits were at 1, 3, 6 months, and every 6 months thereafter.ResultsAfter a median follow-up of 7 months, all patients showed an appropriate biochemical response. Median prostate-specific antigen (PSA) levels before treatment, 1 month, and 6 months after HDR-BT were 2.62 ng/ml (range: 1.55-9.61), 0.97 ng/ml (range: 0.12-3.14), 0.23 ng/ml (range: 0.1-0.74), respectively. Five patients (42%) experienced acute grade 1 GU toxicity and 1 patient (8%) suffered from grade 2 GU toxicity. Regarding gastrointestinal (GI) toxicity, 5 patients referred grade 1 acute toxicity and 1 grade 2 (proctitis). No late toxicity has been observed so far.ConclusionsMRI-TRUS fusion guided salvage HDR-BT +/– EBRT is a feasible procedure for patients with local macroscopic relapse in tumor bed after radical prostatectomy. Exquisite selection of patients through mpMRI and choline PET/CT is crucial to avoid overtreatment. A larger number of patients and longer follow-up are required in order to draw more solid conclusions regarding the effectiveness of this strategy.

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“…In this experience, we tested the hypothesis that dose escalation using salvage LDR brachytherapy alone in the setting of a nodular recurrence would result in meaningful benefits with minimal toxicity. The use of brachytherapy has been described in the literature following recurrences after definitive EBRT [ 12 – 14 ], however, there are only a few reports of salvage brachytherapy after prostatectomy [ 15 – 18 ]. Other salvage options include cryotherapy [ 19 ] and HIFU [ 20 , 21 ] but recent experiences describe a limited success with a 5-10% incidence of severe cases of urinary toxicity requiring surgical intervention and biochemical control rates of ∼50%.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of salvage low-dose-rate brachytherapy for prostate bed recurrences following radical prostatectomy

Kumar¹,

Smith²,

Reddy³

et al. 2015

jcb

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PurposeTo report efficacy in our series of nodular recurrences in the post-surgical bed that underwent salvage low-dose-rate (LDR) brachytherapy.Material and methodsPatients with radical prostatectomy (RP) who had biochemical failure with nodular recurrence detected by DRE, ultrasound, and pelvic CT and then salvaged with LDR 125I brachytherapy were included. Nodular recurrences were biopsy confirmed adenocarcinoma, and patients had no evidence of nodal or distant metastasis on imaging including bone scan. Follow up was at least every 6 months with a serial prostate specific antigen (PSA).ResultsTwelve patients had salvage LDR brachytherapy with median age 69 years (range 59-86) and median pre-salvage PSA of 4.22 ng/ml. Nodule biopsy Gleason score was 7, 8, or undifferentiated. Median rectal V100 was 0.00 cc. Compared to pre-salvage, patients reported no additional genitourinary (GU) toxicity. After a median 35 months post-salvage follow up (range 10-81 months), patients had a median PSA nadir of 0.72 ng/ml (range 0.01-22.4). At 6 months post salvage, 90% of patients had a PSA below pre-salvage levels. At last follow up, 4 patients had PSA control.ConclusionsThere was a trend to improved biochemical relapse free survival for lower Gleason score and pre-salvage PSA, which may be indicative of the lack of or only low volume metastatic disease. LDR brachytherapy is an effective salvage technique and can be considered in well selected patients allowing for dose escalation to the nodular recurrence.

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Feasibility and preliminary outcome of salvage combined HDR brachytherapy and external beam radiotherapy (EBRT) for local recurrences after radical prostatectomy

Cited by 25 publications

References 25 publications

Brachytherapy for the treatment of recurrent prostate cancer after radiotherapy or radical prostatectomy

Brachytherapy for the treatment of recurrent prostate cancer after radiotherapy or radical prostatectomy

Salvage high-dose-rate brachytherapy for histologically confirmed macroscopic local relapsed prostate cancer after radical prostatectomy

Safety and efficacy of salvage low-dose-rate brachytherapy for prostate bed recurrences following radical prostatectomy

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