Salvage brachytherapy in prostate local recurrence after radiation therapy: predicting factors for control and toxicity
Por:
Henriquez, I, Sancho, G, Hervas, A, Guix, B, Pera, J, Gutierrez, C, Abuchaibe, O, Martinez-Monge, R, Tormo, A, Polo, A
Publicada:
30 abr 2014
Resumen:
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 (BED2 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 BED2 (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 BED2 Gy (alpha/beta 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.
Filiaciones:
Henriquez, I:
Univ Hosp St Joan, Inst Invest Sanitaria Pere Virgili, Dept Radiat Oncol, Tarragona, Spain
IMOR, Radiat Oncol Med Inst, Dept Radiat Oncol, Barcelona, Spain
Sancho, G:
Hosp Santa Creu & Sant Pau, Dept Radiat Oncol, Barcelona, Spain
Hervas, A:
Hosp Ramon & Cajal, Dept Radiat Oncol, Brachytherapy Unit, E-28034 Madrid, Spain
Guix, B:
IMOR, Radiat Oncol Med Inst, Dept Radiat Oncol, Barcelona, Spain
Pera, J:
Inst Catala Oncol, Dept Radiat Oncol, Brachytherapy Unit, Barcelona, Spain
Gutierrez, C:
Inst Catala Oncol, Dept Radiat Oncol, Brachytherapy Unit, Barcelona, Spain
Abuchaibe, O:
Virgilio Galvis Ramirez Canc Ctr, Dept Radiat Oncol, Bucaramanga, Colombia
Martinez-Monge, R:
Univ Navarra Clin, CUN, Dept Radiat Oncol, Pamplona, Spain
Tormo, A:
Univ Hosp Politecn La Fe, Dept Radiat Oncol, Valencia, Spain
Polo, A:
Hosp Ramon & Cajal, Dept Radiat Oncol, Brachytherapy Unit, E-28034 Madrid, Spain
Gold, Green Published
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