Focal MRI-Guided Salvage High-Dose-Rate Brachytherapy in Patients With Radiorecurrent Prostate Cancer
Maenhout, Metha; Peters, Max; van Vulpen, Marco; Moerland, Marinus A.; Meijer, Richard P.; van den Bosch, Maurice A.A.J.; Nguyen, Paul L.; Frank, Steven J.; van der Voort van Zyp, Jochem R.N.
(2017) Technology in cancer research & treatment, volume 16, issue 6, pp. 1194 - 1201
(Article)
Abstract
Introduction: Whole-gland salvage treatment of radiorecurrent prostate cancer has a high rate of severe toxicity. The standard of care in case of a biochemical recurrence is androgen deprivation treatment, which is associated with morbidity and negative effects on quality of life. A salvage treatment with acceptable toxicity might postpone the
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start of androgen deprivation treatment, might have a positive influence on the patients’ quality of life, and might even be curative. Here, toxicity and biochemical outcome are described after magnetic resonance imaging–guided focal salvage high-dose-rate brachytherapy in patients with radiorecurrent prostate cancer. Materials and Methods: Seventeen patients with pathologically proven locally recurrent prostate cancer were treated with focal high-dose-rate brachytherapy in a single 19-Gy fraction using magnetic resonance imaging for treatment guidance. Primary radiotherapy consisted of external beam radiotherapy or low-dose-rate brachytherapy. Tumors were delineated with Ga-68–prostate-specific membrane antigen or F18-choline positron emission tomography in combination with multiparametric magnetic resonance imaging. All patients had a prostate-specific antigen level of less than 10 ng/mL at the time of recurrence and a prostate-specific antigen doubling time of ≥12 months. Toxicity was measured by using the Common Terminology Criteria for Adverse Events version 4. Results: Eight of 17 patients had follow-up interval of at least 1 year. At a median follow-up interval of 10 months (range 3-40 months), 1 patient experienced a biochemical recurrence according to the Phoenix criteria, and prostate-specific membrane antigen testing revealed that this was due to a distant nodal metastasis. One patient had a grade 3 urethral stricture at 2 years after treatment. Conclusion: Focal salvage high-dose-rate brachytherapy in patients with radiorecurrent prostate cancer showed grade 3 toxicity in 1 of 17 patients and a distant nodal metastasis in another patient. Whether this treatment option leads to cure in a subset of patients or whether it can successfully postpone androgen deprivation treatment needs further investigation.
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Keywords: focal treatment, HDR brachytherapy, MRI guidance, recurrent prostate cancer, salvage treatment, Radiotherapy Dosage, Glutamate Carboxypeptidase II/genetics, Humans, Middle Aged, Neoplasm Recurrence, Local/etiology, Male, Radiation Injuries/etiology, Brachytherapy/adverse effects, Antigens, Surface/genetics, Prostatic Neoplasms/complications, Salvage Therapy/adverse effects, Aged, 80 and over, Gallium Radioisotopes/adverse effects, Aged, Prostate, Oncology, Cancer Research, Journal Article, Research Support, N.I.H., Extramural
ISSN: 1533-0346
Publisher: Adenine Press
Note: Publisher Copyright: © The Author(s) 2017. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.
(Peer reviewed)