Salvage I-125 brachytherapy for locally-recurrent prostate cancer after radiotherapy

Fecha de publicación: 01/09/2020 Fecha Ahead of Print: 05/07/2020

Autores de IIS La Fe

• Olga Pons Llanas

  Autor

• Susana Roldan Ortega

  Autor

• Antonio Conde Moreno

  Autor

• Francisco Javier Celada Álvarez

  Autor

• Carlos Ruiz Martinez

  Autor

• Françoise Lliso Valverde

  Autor

• Alejandro Tormo Mico

  Autor

• José Pérez Calatayud

  Autor

Participantes ajenos a IIS La Fe

• Burgos-Burgos J
• López-Torrecilla J

Grupos

• Investigación Clínica y Traslacional en Cáncer

  

  Leader

  José Gómez Codina

• Unidad Mixta de Investigación en Radiofísica e Instrumentación nuclear en medicina

  Leader

  Facundo Ballester Pallares

Abstract

Purpose: Retrospective, single-institution analysis of clinical outcomes and treatment-related toxicity in patients treated with salvage I-125 low-dose rate (LDR) brachytherapy (BT) for locally-recurrent prostate cancer after radiotherapy. Materials and methods: Between 2008 and 2018, 30 patients with biopsy-confirmed prostate cancer recurrence underwent salvage treatment with 1-125 LDR-BT. Of these 30 patients, 14 were previously treated with primary external beam radiotherapy (EBRT; median dose, 73 Gy) and 16 with primary I-125 LDR-BT (145 Gy and 160 Gy in 14 and 2 cases, respectively). At seed implantation, the mean age was 75.8 years, with a median Gleason score of 7 and pre-salvage PSA of <10 ng/mL. Six patients received androgen deprivation therapy for six months after relapse diagnosis. The prescribed salvage 1-125 BT dose to the gland was 120-130 Gy, with dose restrictions of Dmax <135% (urethra) and <100% (rectum). Toxicity was evaluated according to the CTCAE scale (v4.0). Results: At a median follow-up of 45 months, the biochemical recurrence-free survival rates at 1, 3 and 5 years were 86.7%, 56.7% and 53.3%, respectively. Overall survival at 5 years was 87%. On the multivariate analysis, two variables were significant predictors of recurrence: PSA at relapse and nadir PSA post-salvage. Grade 3 genitourinary toxicity was observed in 5 patients (radiation-induced cystitis in 3 cases and urethral stenosis in 2) and G3 gastrointestinal toxicity in 3 patients (rectal bleeding). Conclusion: Salvage therapy with I-125 brachytherapy is a safe and effective treatment option for locally-recurrent prostate cancer in previously-irradiated patients. High pre-salvage PSA and post-salvage nadir PSA values were significantly associated with a worse disease control after salvage 1-125 LDR-BT. In well-selected patients, 1-125 LDR-BT is comparable to other salvage therapies in terms of disease control and toxicity. However, more research is needed to determine the optimal management of locally-recurrent prostate cancer. (C) 2020 Greater Poland Cancer Centre. Published by Elsevier B.V. All rights reserved.

Keywords

• Prostate cancer; Salvage brachytherapy; Permanent seed 1-125 implant