title: High-dose-rate brachytherapy with or without intensity modulated radiation therapy as salvage treatment for an isolated, gross local recurrence of prostate cancer post-prostatectomy.
abstract: OBJECTIVE
  To evaluate the use of high-dose-rate (HDR) brachytherapy ± intensity modulated radiation therapy (IMRT) as salvage therapy for patients with an isolated, gross local recurrence of prostate cancer after radical prostatectomy.
  
  
  METHODS
  Between October 2009 and May 2013, the authors treated six patients with salvage iridium-192 HDR brachytherapy ± IMRT for biopsy-proven, recurrent prostate cancer post-prostatectomy. In each patient, a pelvic MRI scan or CT scan demonstrated a nodule (range 1.6, 4.7 cm) in the prostate bed. Although prostate-specific antigen values were 0.2-9.5 ng/mL at the time of salvage brachytherapy, there was no pelvic adenopathy on CT or MRI scan, and a bone scan was negative in all cases. Five patients were treated with IMRT to 4500-5040 cGy in 25-28 fractions to the prostate bed followed by two 950 cGy HDR brachytherapy fractions separated by 1-2 weeks. A sixth patient underwent HDR brachytherapy monotherapy consisting of 3800 cGy in four fractions over 3 days. Toxicities were graded according to the Common Terminology Criteria for Adverse Events, version 4.0.
  
  
  RESULTS
  Median followup was 9 months (range 3, 40 months). All six patients have been free of androgen deprivation therapy and have an undetectable prostate-specific antigen. One patient developed late Grade 2 urinary incontinence. There was no late grade ≥2 gastrointestinal toxicity.
  
  
  CONCLUSIONS
  HDR brachytherapy ± IMRT is a safe and effective salvage therapy option for an isolated, gross local recurrence of prostate cancer after radical prostatectomy and merits further study.
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Tobin J
authors.initials: TJ
authors.lastname: Strom
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Wilder
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Fernandez
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Mellon
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Amarjit S
authors.initials: AS
authors.lastname: Saini
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Dylan C
authors.initials: DC
authors.lastname: Hunt
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL. Electronic address: matthew.biagioli.@mofitt.org.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Biagioli
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000209:etiology; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects
chemical_list: D007496:Iridium Radioisotopes; D017430:Prostate-Specific Antigen
keywords: Brachytherapy; HDR; Iridium; Prostatectomy; Prostatic neoplasms; Salvage therapy