title: Salvage prostate HDR brachytherapy combined with interstitial hyperthermia for local recurrence after radiation therapy failure.
abstract: OBJECTIVE
  The aim of the present retrospective study is to evaluate toxicity and early clinical outcomes of interstitial hyperthermia (IHT) combined with high-dose rate (HDR) brachytherapy as a salvage treatment in patients with biopsy-confirmed local recurrence of prostate cancer after previous external beam radiotherapy.
  
  
  METHODS
  Between September 2008 and March 2013, 25 patients with local recurrence of previously irradiated prostate cancer were treated. The main eligibility criteria for salvage prostate HDR brachytherapy combined with interstitial hyperthermia were biopsy confirmed local recurrence and absence of nodal and distant metastases. All patients were treated with a dose of 30 Gy in 3 fractions at 21-day intervals. We performed 62 hyperthermia procedures out of 75 planned (83 %). The aim of the hyperthermia treatment was to heat the prostate to 41-43 °C for 60 min. Toxicity for the organs of the genitourinary system and rectum was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE, v. 4.03). Determination of subsequent biochemical failure was based on the Phoenix definition (nadir + 2 ng/ml).
  
  
  RESULTS
  The median age was 71 years (range 62-83 years), the median initial PSA level was 16.3 ng/ml (range 6.37-64 ng/ml), and the median salvage PSA level was 2.8 ng/ml (1.044-25.346 ng/ml). The median follow-up was 13 months (range 4-48 months). The combination of HDR brachytherapy and IHT was well tolerated. The most frequent complications were nocturia, weak urine stream, urinary frequency, hematuria, and urgency. Grade 2 rectal hemorrhage was observed in 1 patient. No grade 3 or higher complications were observed. The 2-year Kaplan-Meier estimate of biochemical control after salvage treatment was 74 %. The PSA in 20 patients decreased below the presalvage level, while 11 patients achieved a PSA nadir < 0.5 ng/ml. All patients are still alive. Of the 7 patients who experienced biochemical failure, bone metastases were found in 2 patients.
  
  
  CONCLUSIONS
  IHT in combination with salvage HDR brachytherapy is a well tolerated and effective treatment.
authors: Department of Radiotherapy, Centre of Oncology, M. Skłodowska - Curie Institute, Krakow Branch, ul. Garncarska 11, 31-115, Krakow, Poland, drkukielka@gmail.com.
authors: A M
authors: AM
authors: Kukiełka
authors: M
authors: M
authors: Hetnał
authors: T
authors: T
authors: Dąbrowski
authors: T
authors: T
authors: Walasek
authors: P
authors: P
authors: Brandys
authors: D
authors: D
authors: Nahajowski
authors: R
authors: R
authors: Kudzia
authors: D
authors: D
authors: Dybek
authors: M
authors: M
authors: Reinfuss
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D019233:Retreatment; D016879:Salvage Therapy; D017211:Treatment Failure