Salvage high dose rate brachytherapy for recurrent prostate
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Salvage high-dose-rate brachytherapy (sHDRBT) for locally recurrent prostate cancer after definitive radiation is associated with biochemical control in approximately half of the patients at 3-5 years.

Researchers performed a retrospective analysis of 129 patients who underwent whole-gland sHDRBT between 1998-2016. They evaluated clinical factors associated with biochemical control as well as toxicity.

At diagnosis, the median PSA was 7.77 ng/mL. The majority of patients had T1-2 and Gleason 6-7 disease. 71% received external beam RT alone, while 22% received permanent prostate implants.

--The median disease-free interval (DFI) was 56 months, and the median pre-salvage PSA was 4.95ng/mL. At sHDRBT, 46% had T3 disease and 51% had Gleason 8-10 disease.

--At a median of 68 months following sHDRBT, 3 and 5-year disease-free survival were 85% and 71%, respectively. Median PSA nadir was 0.18 ng/mL, achieved a median of 10 months after sHDRBT.

--Patients with ≥35%+ cores and a DFI <4.1 years had worse biochemical control. Local failure was seen in 11% of patients.

--14 patients developed acute urinary obstruction requiring Foley placement and 19 patients developed strictures requiring dilation.

In particular, sHDRBT is a reasonable option for patients with locally recurrent prostate cancer following definitive RT. Those with <35%+ cores or an initial DFI of ≥4.1 years may be more likely to achieve long-term disease control following sHDRBT.

Practical Radiation Oncology
Source: https://doi.org/10.1016/j.prro.2021.04.007
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