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Safety and efficacy of salvage high-dose rate brachytherapy for prostate-bed recurrences following radical prostatectomy and external beam radiotherapy

  • Urology - Original Paper
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Abstract

Purpose

This retrospective study aims to evaluate the efficacy and safety of salvage HDR brachytherapy in second local recurrences of prostate cancer after applying radical prostatectomy (RP) and post-operative external beam radiotherapy (EBRT).

Materials and methodology

Fifteen patients with locally recurrent prostate cancer after RP and EBRT were salvaged with HDR brachytherapy. Patients had no nodal or distant metastasis evidence on imaging findings, including whole body bone scan, CT scan, and MRI or PSMA PET scan. HDR brachytherapy was applied with 36 Gy in four fractions, in two implantations with 1 week apart. We followed the patients for a control visit every 3 months for 2 years, and every 6 months thereafter.

Results

Fifteen patients with the mean age of 64 years (ranged 51–79) underwent salvage HDR brachytherapy. The mean baseline level of PSA was calculated 2.26 ng/ml (ranged from 0.21 to 9, SD = 2.33), which has been significantly decreased in all patients. Hence, two of our patients experienced a biochemical failure during the follow-up period. Our results showed that 86.6% (n = 13) of patients had never experienced a significant increment in PSA level after a median follow-up of 48 months (ranging from 12 to 132 months). Besides, salvage HDR brachytherapy did not induce any significant side effects such as acute or late rectal complications, despite causing urinary complication.

Conclusions

HDR brachytherapy could be considered as a treatment in well-selected patients with the second recurrence in their prostatic bed after the former EBRT allowing for dose escalating to the second nodular recurrence.

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Acknowledgements

The authors are thankful to the patients and hospital staff for their collaboration.

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Authors and Affiliations

  1. Radiation Oncology Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    Mahdi Aghili, Fatemeh Jafari, Maisa Yamrali & Ramin Jaberi

  2. Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mahdi Aghili, Fatemeh Jafari, Maisa Yamrali & Ramin Jaberi

  3. Advanced Radiation Oncology Department-Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (VR), Verona, Italy

    Francesco Cuccia

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  1. Mahdi Aghili
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  2. Fatemeh Jafari
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  3. Maisa Yamrali
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Correspondence to Mahdi Aghili or Fatemeh Jafari.

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Aghili, M., Jafari, F., Yamrali, M. et al. Safety and efficacy of salvage high-dose rate brachytherapy for prostate-bed recurrences following radical prostatectomy and external beam radiotherapy. Int Urol Nephrol 54, 1031–1037 (2022). https://doi.org/10.1007/s11255-022-03155-y

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  • DOI: https://doi.org/10.1007/s11255-022-03155-y

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