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Salvage brachytherapy for locally recurrent prostate cancer after single-fraction 19 Gy high-dose-rate brachytherapy: toxicity, prostate-specific antigen kinetics, and cancer control
Journal of Contemporary Brachytherapy ( IF 1.1 ) Pub Date : 2021-02-17 , DOI: 10.5114/jcb.2021.103581 Esther Mayrata 1 , Jose Maria Espinosa 2 , David Büchser 1 , Francisco Casquero 1 , Fernan Suárez 1 , Alba González 1 , Pablo Minguez 2 , Jose Fernando Pérez 2 , Iñigo San Miguel 1 , Jon Cacicedo 1 , Alfonso Gómez-Iturriaga 1
Journal of Contemporary Brachytherapy ( IF 1.1 ) Pub Date : 2021-02-17 , DOI: 10.5114/jcb.2021.103581 Esther Mayrata 1 , Jose Maria Espinosa 2 , David Büchser 1 , Francisco Casquero 1 , Fernan Suárez 1 , Alba González 1 , Pablo Minguez 2 , Jose Fernando Pérez 2 , Iñigo San Miguel 1 , Jon Cacicedo 1 , Alfonso Gómez-Iturriaga 1
Affiliation
Introduction
To evaluate toxicity, prostate-specific antigen (PSA) kinetics, and cancer control of high-dose-rate brachytherapy (HDR-BT) as a salvage modality for men with locally recurrent prostate cancer, after primary HDR-BT failure.
Material and methods
Twelve patients with biochemical failure and a local relapse after 19 Gy single-fraction high-dose-rate brachytherapy (HDR-BT 19 Gy) were salvaged using two HDR-BT fractions. Salvage treatment consisted of two HDR-BT applications, one week apart, delivering 12 Gy to the prostate per application (HDR-BT 12 × 2).
Results
Median age and initial PSA prior to rescue treatment were 74 years (range, 65-80) and 5.29 ng/ml (range, 2.37-16.40), respectively. Forty-two percent had a low-risk and 58% presented with intermediate-risk prostate cancer. Median follow-up period was 26 months (range, 10-42). Median time to PSA nadir was 12 months, with a median value of 0.21 ng/ml. Most of the patients (11 of 12) achieved a PSA decline ≥ 90%. Acute grade 2 genitourinary (GU) toxicity occurred in 4 patients (33.3%) and none presented with acute gastrointestinal (GI) toxicity. Two patients (16.7%) suffered from late GU grade 2 toxicity. No grade 3 toxicity were recorded. To date, 2 patients (16.7%) have experienced biochemical failure after salvage treatment.
Conclusions
Salvage HDR-BT 12 × 2 is a feasible and well-tolerated treatment, with acceptable toxicity rates for men with locally recurrent prostate cancer, who failed after HDR-BT with 19 Gy. Moreover, PSA kinetics and cancer control after salvage treatment suggest that this strategy might be efficacious in this clinical setting.
中文翻译：
单次19 Gy高剂量率近距离放射治疗后的局部近距离前列腺癌抢救近距离放射疗法：毒性，前列腺特异性抗原动力学和癌症控制
简介
为了评估原发性HDR-BT失败后男性局部复发性前列腺癌的挽救方式，评估高剂量率近距离放射疗法（HDR-BT）的毒性，前列腺特异性抗原（PSA）动力学和癌症控制。
材料和方法
使用两个HDR-BT组分挽救12例生化衰竭且19 Gy单次高剂量率近距离放射治疗（HDR-BT 19 Gy）后局部复发的患者。挽救治疗包括两次HDR-BT施用，每星期一次，每次施用可为前列腺提供12 Gy的剂量（HDR-BT 12×2）。
结果
抢救治疗前的中位年龄和初始PSA分别为74岁（范围65-80）和5.29 ng / ml（范围2.37-16.40）。42％的患者为低危人群，58％的患者为中危前列腺癌。中位随访期为26个月（范围10-42）。PSA最低点的中位时间为12个月，中位数为0.21 ng / ml。大多数患者（12名患者中的11名）PSA下降≥90％。急性2级泌尿生殖系统（GU）毒性发生在4例患者中（33.3％），无一例出现急性胃肠道（GI）毒性。2名患者（16.7％）患有晚期GU 2级毒性。没有记录到3级毒性。迄今为止，有2名患者（16.7％）在抢救治疗后经历了生化衰竭。
结论
挽救HDR-BT 12×2是一种可行且耐受良好的治疗方法，对于局部复发性前列腺癌的男性（在接受19 Gy的HDR-BT治疗后失败的男性），毒性反应率可以接受。此外，抢救治疗后的PSA动力学和癌症控制表明，这种策略在这种临床情况下可能是有效的。
更新日期：2021-02-17
To evaluate toxicity, prostate-specific antigen (PSA) kinetics, and cancer control of high-dose-rate brachytherapy (HDR-BT) as a salvage modality for men with locally recurrent prostate cancer, after primary HDR-BT failure.
Material and methods
Twelve patients with biochemical failure and a local relapse after 19 Gy single-fraction high-dose-rate brachytherapy (HDR-BT 19 Gy) were salvaged using two HDR-BT fractions. Salvage treatment consisted of two HDR-BT applications, one week apart, delivering 12 Gy to the prostate per application (HDR-BT 12 × 2).
Results
Median age and initial PSA prior to rescue treatment were 74 years (range, 65-80) and 5.29 ng/ml (range, 2.37-16.40), respectively. Forty-two percent had a low-risk and 58% presented with intermediate-risk prostate cancer. Median follow-up period was 26 months (range, 10-42). Median time to PSA nadir was 12 months, with a median value of 0.21 ng/ml. Most of the patients (11 of 12) achieved a PSA decline ≥ 90%. Acute grade 2 genitourinary (GU) toxicity occurred in 4 patients (33.3%) and none presented with acute gastrointestinal (GI) toxicity. Two patients (16.7%) suffered from late GU grade 2 toxicity. No grade 3 toxicity were recorded. To date, 2 patients (16.7%) have experienced biochemical failure after salvage treatment.
Conclusions
Salvage HDR-BT 12 × 2 is a feasible and well-tolerated treatment, with acceptable toxicity rates for men with locally recurrent prostate cancer, who failed after HDR-BT with 19 Gy. Moreover, PSA kinetics and cancer control after salvage treatment suggest that this strategy might be efficacious in this clinical setting.
中文翻译：
单次19 Gy高剂量率近距离放射治疗后的局部近距离前列腺癌抢救近距离放射疗法：毒性，前列腺特异性抗原动力学和癌症控制
简介
为了评估原发性HDR-BT失败后男性局部复发性前列腺癌的挽救方式，评估高剂量率近距离放射疗法（HDR-BT）的毒性，前列腺特异性抗原（PSA）动力学和癌症控制。
材料和方法
使用两个HDR-BT组分挽救12例生化衰竭且19 Gy单次高剂量率近距离放射治疗（HDR-BT 19 Gy）后局部复发的患者。挽救治疗包括两次HDR-BT施用，每星期一次，每次施用可为前列腺提供12 Gy的剂量（HDR-BT 12×2）。
结果
抢救治疗前的中位年龄和初始PSA分别为74岁（范围65-80）和5.29 ng / ml（范围2.37-16.40）。42％的患者为低危人群，58％的患者为中危前列腺癌。中位随访期为26个月（范围10-42）。PSA最低点的中位时间为12个月，中位数为0.21 ng / ml。大多数患者（12名患者中的11名）PSA下降≥90％。急性2级泌尿生殖系统（GU）毒性发生在4例患者中（33.3％），无一例出现急性胃肠道（GI）毒性。2名患者（16.7％）患有晚期GU 2级毒性。没有记录到3级毒性。迄今为止，有2名患者（16.7％）在抢救治疗后经历了生化衰竭。
结论
挽救HDR-BT 12×2是一种可行且耐受良好的治疗方法，对于局部复发性前列腺癌的男性（在接受19 Gy的HDR-BT治疗后失败的男性），毒性反应率可以接受。此外，抢救治疗后的PSA动力学和癌症控制表明，这种策略在这种临床情况下可能是有效的。
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