High-dose-rate brachytherapy with or without intensity modulated radiation therapy as salvage treatment for an isolated, gross local recurrence of prostate cancer post-prostatectomy

Tobin J. Strom, Richard B. Wilder, Daniel C. Fernandez, Eric A. Mellon, Amarjit S. Saini, Dylan C. Hunt, Matthew C. Biagioli

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Purpose: To evaluate the use of high-dose-rate (HDR) brachytherapy±intensity modulated radiation therapy (IMRT) as salvage therapy for patients with an isolated, gross local recurrence of prostate cancer after radical prostatectomy. Methods and Materials: Between October 2009 and May 2013, the authors treated six patients with salvage iridium-192 HDR brachytherapy±IMRT for biopsy-proven, recurrent prostate cancer post-prostatectomy. In each patient, a pelvic MRI scan or CT scan demonstrated a nodule (range 1.6, 4.7cm) in the prostate bed. Although prostate-specific antigen values were 0.2-9.5ng/mL at the time of salvage brachytherapy, there was no pelvic adenopathy on CT or MRI scan, and a bone scan was negative in all cases. Five patients were treated with IMRT to 4500-5040cGy in 25-28 fractions to the prostate bed followed by two 950cGy HDR brachytherapy fractions separated by 1-2weeks. A sixth patient underwent HDR brachytherapy monotherapy consisting of 3800cGy in four fractions over 3 days. Toxicities were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. Results: Median followup was 9 months (range 3, 40 months). All six patients have been free of androgen deprivation therapy and have an undetectable prostate-specific antigen. One patient developed late Grade 2 urinary incontinence. There was no late grade ≥2 gastrointestinal toxicity. Conclusions: HDR brachytherapy±IMRT is a safe and effective salvage therapy option for an isolated, gross local recurrence of prostate cancer after radical prostatectomy and merits further study.

Original languageEnglish (US)
Pages (from-to)123-127
Number of pages5
JournalBrachytherapy
Volume13
Issue number2
DOIs
StatePublished - Mar 2014
Externally publishedYes

Keywords

  • Brachytherapy
  • HDR
  • Iridium
  • Prostatectomy
  • Prostatic neoplasms
  • Salvage therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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