title: Feasibility and preliminary outcome of salvage combined HDR brachytherapy and external beam radiotherapy (EBRT) for local recurrences after radical prostatectomy.
abstract: OBJECTIVE
  Feasibility of combined fractionated intensity modulated brachytherapy (IMBT) and external beam radiotherapy (EBRT) as well as the effect of local dose escalation was investigated in a non-randomized retrospective observation trial for histologically-proven macroscopic local recurrences of prostate cancer after radical prostatectomy.
  
  
  METHODS
  Thirty-five patients with transrectal ultrasound (TRUS) detectable tumors were treated. Applied dose per IMBT fraction was 15 Gy, prescribed on the target (TRUS visible tumor) surface. For the first 21 patients, two fractions of IMBT were delivered in 2 weeks interval, complementary to 30 Gy EBRT to the small pelvis. Further, as second step of dose escalation, 14 patients were treated with 2 x 15 Gy IMBT combined with 40 Gy EBRT. The total treatment time was 4 and 5 weeks, respectively.
  
  
  RESULTS
  PSA was decreased in 34 out of 35 patients post-therapeutically. After a mean follow-up of 27 months, 32 out of 35 patients are alive. However, in 67% of the patients, we observed postimplant PSA elevation with or without detectable local and/or systemic progress. The mean duration of biochemical non-evidence of disease (bNED) after radiation was 12 months for all patients (31% in the 30 Gy group and 42% in the 40 Gy group). No RTOG/EORTC grade III or IV side effects were registered during/after radiotherapy.
  
  
  CONCLUSIONS
  Combined EBRT and IMBT-boost of TRUS detectable recurrences of prostate cancer after radical prostatectomy seems to be a feasible method of salvage treatment. These early results need to be confirmed by further prospective randomized trials and by longer follow-up in all dose groups.
authors.affiliation: Interdisciplinary Brachytherapy Centre, Schleswig-Holstein University Hospital, Kiel, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Niehoff
authors.forename: Tilmann
authors.initials: T
authors.lastname: Loch
authors.forename: Niels
authors.initials: N
authors.lastname: Nürnberg
authors.forename: Razvan
authors.initials: R
authors.lastname: Galalae
authors.forename: Jan
authors.initials: J
authors.lastname: Egberts
authors.forename: Peter
authors.initials: P
authors.lastname: Kohr
authors.forename: György
authors.initials: G
authors.lastname: Kovács
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011182:Postoperative Care / Q000379:methods; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome