The potential of low-dose-rate brachytherapy with iodine-125 in the treatment of local recurrences of prostate cancer after primary high-dose-rate monotherapy.

IF 1.1 4区 医学 Q4 ONCOLOGY Journal of Contemporary Brachytherapy Pub Date : 2023-04-01 DOI:10.5114/jcb.2023.126618
Wojciech M Burchardt, Artur J Chyrek, Grzegorz M Bielęda, Ewa Burchardt, Adam Chicheł
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Abstract

Purpose: The incidence of local prostate cancer recurrences after monotherapy with high-dose-rate brachytherapy (HDR-BT) is low. However, a cumulated number of local recurrences during follow-up is naturally observed in highly specialized oncological centers. This retrospective study aimed to present the treatment of local recurrences after HDR-BT with low-dose-rate brachytherapy (LDR-BT).

Material and methods: Nine patients with low- and intermediate-risk prostate cancer with a median age of 71 years (range, 59-82 years) were diagnosed with local recurrences after previous monotherapy HDR-BT, 3 × 10.5 Gy (from 2010 to 2013). Median time to biochemical recurrence was 59 months (range, 21-80 months). All patients received 145 Gy with salvage LDR-BT (iodine-125). Gastrointestinal and urological toxicities were evaluated based on patients' records following CTCAE v. 4.0 and IPSS scales.

Results: The median follow-up after salvage treatment was 30 months (range, 17-63 months). Local recurrences (LR) were detected in two cases, and the actuarial 2-year local control was 88%. Biochemical failure was observed in four cases. Distant metastases (DM) were observed in 2 patients. In one patient, both LR and DM were diagnosed simultaneously. Four patients had no relapse of the disease, and a 2-year disease-free survival (DSF) was 58.3%. Before salvage treatment, median IPSS scores were 6.5 points (range, 1-23 points). At the first follow-up visit, after one month, the mean IPSS score was 20 points, and at the last follow-up visit, it was 8 points (range, 1-26 points). One patient had urinary retention after treatment. There was no significant change in IPSS scores before and after the treatment (p = 0.68). Two patients had grade 1 toxicity in the gastrointestinal tract.

Conclusions: Salvage LDR-BT for patients with prostate cancer previously treated with HDR-BT monotherapy is characterized by acceptable toxicity, and may result in local disease control.

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低剂量-125近距离放射治疗原发性高剂量单药治疗后前列腺癌局部复发的潜力
目的:单次高剂量率近距离放疗(HDR-BT)后前列腺癌局部复发率低。然而,在高度专业化的肿瘤中心,随访期间累积的局部复发数量自然是观察到的。本回顾性研究旨在介绍低剂量率近距离放疗(LDR-BT)治疗HDR-BT术后局部复发的方法。材料与方法:2010 - 2013年9例低、中危前列腺癌患者,中位年龄71岁(范围59-82岁),既往单药HDR-BT治疗3 × 10.5 Gy后诊断为局部复发。到生化复发的中位时间为59个月(范围21-80个月)。所有患者均接受145 Gy补救性LDR-BT(碘-125)治疗。根据CTCAE v. 4.0和IPSS评分对患者的胃肠道和泌尿系统毒性进行评估。结果:抢救治疗后中位随访时间为30个月(范围17-63个月)。2例发现局部复发(LR),精算2年局部控制率为88%。4例出现生化失败。2例患者出现远处转移。1例患者同时诊断为LR和DM。4例患者无复发,2年无病生存率(DSF)为58.3%。打捞治疗前,IPSS评分中位数为6.5分(范围1-23分)。1个月后第一次随访时IPSS平均评分为20分,最后一次随访时IPSS平均评分为8分(范围1-26分)。1例患者治疗后出现尿潴留。治疗前后IPSS评分差异无统计学意义(p = 0.68)。2例患者胃肠道毒性为1级。结论:补救性LDR-BT对既往HDR-BT单药治疗的前列腺癌患者具有可接受的毒性,并可能实现局部疾病控制。
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来源期刊
Journal of Contemporary Brachytherapy
Journal of Contemporary Brachytherapy ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
2.40
自引率
14.30%
发文量
54
审稿时长
16 weeks
期刊介绍: The “Journal of Contemporary Brachytherapy” is an international and multidisciplinary journal that will publish papers of original research as well as reviews of articles. Main subjects of the journal include: clinical brachytherapy, combined modality treatment, advances in radiobiology, hyperthermia and tumour biology, as well as physical aspects relevant to brachytherapy, particularly in the field of imaging, dosimetry and radiation therapy planning. Original contributions will include experimental studies of combined modality treatment, tumor sensitization and normal tissue protection, molecular radiation biology, and clinical investigations of cancer treatment in brachytherapy. Another field of interest will be the educational part of the journal.
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