title: Focal salvage iodine-125 brachytherapy for prostate cancer recurrences after primary radiotherapy: a retrospective study regarding toxicity, biochemical outcome and quality of life.
abstract: OBJECTIVE
  Whole-gland salvage for recurrent prostate cancer (PCa) shows high failure and toxicity rates. Early and adequate localization of recurrences enables focal salvage, thereby potentially improving functional outcomes, while maintaining cancer control.
  
  
  METHODS
  Retrospective analysis yielded 20 focal salvage I125 brachytherapy patients for locally recurrent PCa after primary radiotherapy. Tumor was defined by multiparametric MRI and correspondence with transrectal biopsies. Dose data were obtained intra-operatively. The tumor was prescribed ⩾144 Gy. Toxicity was scored by the Common Terminology Criteria for Adverse Events version 4 (CTCAE-4). Biochemical failure (BF) was defined using the Phoenix criteria (PSA-nadir + 2.0 ng/ml). Quality of life (QoL) was measured by SF-36 Health Survey and European Organization of Research and Treatment of Cancer (EORTC) C30+3 and PR25 questionnaires.
  
  
  RESULTS
  With a median follow-up of 36 months (range 10-45), six patients experienced BF, of which three had no initial response. Grade 3 genitourinary (GU) toxicity occurred in one patient (a urethral stricture). The five previously potent patients retained erectile function. QoL remained decreased with regard to urinary symptoms.
  
  
  CONCLUSIONS
  Focal salvage I125 brachytherapy showed one grade 3 GU toxicity in the 20 treated patients. Biochemical response and QoL were acceptable.
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands. Electronic address: m.peters-10@umcutrecht.nl.
authors.forename: Max
authors.initials: M
authors.lastname: Peters
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands. Electronic address: M.maenhout@umcutrecht.nl.
authors.forename: Metha
authors.initials: M
authors.lastname: Maenhout
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
authors.forename: Jochem R N
authors.initials: JR
authors.lastname: van der Voort van Zyp
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
authors.forename: Marinus A
authors.initials: MA
authors.lastname: Moerland
authors.affiliation: Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Maaike R
authors.initials: MR
authors.lastname: Moman
authors.affiliation: Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
authors.forename: Lotte M G
authors.initials: LM
authors.lastname: Steuten
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
authors.forename: Marijke J H
authors.initials: MJ
authors.lastname: van Deursen
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: van Vulpen
mesh_terms: D000368:Aged; D001706:Biopsy; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D007610:Kallikreins / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011788:Quality of Life; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000209:etiology
chemical_list: D007457:Iodine Radioisotopes; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Biochemical failure; Focal salvage; I125 brachytherapy; Prostate cancer; Quality of life; Toxicity