title: Salvage low-dose-rate (125)I partial prostate brachytherapy after dose-escalated external beam radiotherapy.
abstract: OBJECTIVE
  To report outcomes on 5 patients treated with salvage partial low-dose-rate (LDR) 125-iodine ((125)I) permanent prostate seed brachytherapy (BT) for biopsy-proven locally persistent prostate cancer, following failure of dose-escalated external beam radiotherapy (EBRT).
  
  
  METHODS
  A retrospective review of the Fox Chase Cancer Center prostate cancer database identified five patients treated with salvage partial LDR (125)I seed implant for locally persistent disease following dose-escalated EBRT to 76-84 Gy in 2 Gy per fraction equivalent. All patients had post-EBRT biopsies confirming unilateral locally persistent prostate cancer. Pre-treatment, EBRT and BT details, as well as post-treatment characteristics were documented and assessed.
  
  
  RESULTS
  The median follow-up post-implant was 41 months. All five patients exhibited low acute genitourinary and gastrointestinal toxicities. Increased erectile dysfunction was noted in three patients. There were no biochemical failures following salvage LDR (125)I seed BT to date, with a median post-salvage PSA of 0.4 ng/mL.
  
  
  CONCLUSIONS
  In carefully selected patients with local persistence of disease, partial LDR (125)I permanent prostate seed implant appears to be a feasible option for salvage local therapy with an acceptable toxicity profile. Further study is needed to determine long-term results of this approach.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Chang
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Buyyounouski
keywords: LDR; brachytherapy; prostate cancer; recurrence; salvage; seeds