Salvage external beam radiotherapy for locally recurrent prostate cancer after definitive brachytherapy.
Patients with locally recurrent prostate cancer after definitive prostate brachytherapy have few evidence-based salvage options. We evaluate the efficacy and treatment-related side-effects of salvage external-beam radiotherapy (EBRT) after definitive prostate brachytherapy (PBT).



Eleven patients previously treated with definitive PBT and with biopsy-proven local-only recurrence received salvage reirradiation with EBRT. Genitourinary (GU) function was assessed with International Prostate Symptom Scores. Treatment-related toxicities were graded using CTCAE v 4.03.



Median follow-up was 26.5 months (range, 1-53.6 months); median age at EBRT salvage was 67 years (range, 61-81 years). Salvage EBRT included the whole pelvis in 8 patients. Two patients were treated with 3D-CRT; 9 underwent IMRT. Five patients (45%) received androgen deprivation therapy concurrent with salvage EBRT as part of long- or short-course hormone therapy. The median prostate dose was 70.2 Gy (range, 64.8-75.6 Gy). Actuarial 3-year overall and biochemical failure-free survival were 77% and 69%, respectively. Five patients (45%) had worsening GU symptoms, and 9 (82%) experienced a decline in erectile function. One patient experienced acute grade 2 GU toxicity. Four patients (36%) experienced late grade ≥2 GI/GU toxicities, including 2 who experienced grade 3 toxicities (rectourethral fistula/incontinence, bladder outlet obstruction). No grade 4/5 toxicities were noted.



Our data suggest that salvage EBRT can provide similar disease control and treatment-related toxicity to more established salvage therapies. This approach warrants further investigation on a larger scale.
Department of Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, FL.
Michael S
MS
Rutenberg
Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
Moshe
M
Meister
Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
Pradip P
PP
Amin
Department of Internal Medicine, Division of Medical Oncology, University of Maryland School of Medicine, Baltimore, MD.
Arif
A
Hussain
Department of Surgery, Division of Urology, University of Maryland School of Medicine, Baltimore, MD.
Michael J
MJ
Naslund
Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD. Electronic address: ykwok@umm.edu.
Young
Y
Kwok
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D052801:Male Urogenital Diseases / Q000209:etiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis
Prostate brachytherapy; Reirradiation; Salvage external beam radiotherapy