title: Salvage brachytherapy in prostate local recurrence after radiation therapy: predicting factors for control and toxicity.
abstract: OBJECTIVE
  To evaluate efficacy and toxicity after salvage brachytherapy (BT) in prostate local recurrence after radiation therapy.
  
  
  METHODS
  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 (BED(2 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 BED(2 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 BED(2 Gy) (α/β 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.
authors.affiliation: Department of Radiation Oncology, University Hospital of Sant Joan, Institute d'Investigació Sanitaria Pere Virgili (IISPV), Reus, Tarragona, Spain. ivanhenriquezlopez@me.com.
authors.forename: Iván
authors.initials: I
authors.lastname: Henríquez
authors.forename: Gemma
authors.initials: G
authors.lastname: Sancho
authors.forename: Asunción
authors.initials: A
authors.lastname: Hervás
authors.forename: Benjamin
authors.initials: B
authors.lastname: Guix
authors.forename: Joan
authors.initials: J
authors.lastname: Pera
authors.forename: Cristina
authors.initials: C
authors.lastname: Gutierrez
authors.forename: Oscar
authors.initials: O
authors.lastname: Abuchaibe
authors.forename: Rafael
authors.initials: R
authors.lastname: Martínez-Monge
authors.forename: Alejandro
authors.initials: A
authors.lastname: Tormo
authors.forename: Alfredo
authors.initials: A
authors.lastname: Polo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000175:diagnosis*; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate
chemical_list: D007457:Iodine Radioisotopes