Journal of contemporary brachytherapy · 2026
Magnetic resonance imaging-guided salvage high-dose-rate brachytherapy for local recurrence after prostatectomy and external beam radiotherapy.
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Willisch Patricia, Vázquez-Barreiro Beatriz, Candal Aldara, Vilchez Ana, Andrade Benito, Lopez-Soliño Saul, Cespón Enrique, Montemuiño Sara, Nieto Iñigo, Carballo-Quinta Manuel, de la Torre Marisa Vázquez, Gomez Francisco Salvador, López Antonio Medina, Muñoz Victor
Аннотация
PURPOSE: To evaluate the safety and efficacy of high-dose-rate (HDR) prostate brachytherapy (BT) in patients with local relapse after initial treatment with radical prostatectomy and salvage external beam radiation therapy (EBRT).
MATERIAL AND METHODS: Patients with local recurrence of prostate adenocarcinoma were retrospectively identified at a single-institution between 2015 and 2024. Recurrence was confirmed by imaging (MRI or choline PET) after prostatectomy and EBRT. Patients had no evidence of distant disease. A total HDR-BT dose of 17 Gy to 20 Gy was administered in two fractions.
RESULTS: Seventeen patients received salvage HDR-BT. The median follow-up time was 74 months (range, 6-100). Twelve patients (70.6%) received salvage-intent EBRT after surgery, while five (29.4%) had adjuvant EBRT. Three patients received androgen deprivation therapy (ADT) concurrently with EBRT in a mean ADT duration of 72 months (range, 6-126). The median time to PSA nadir after EBRT was 14 months. The median interval between EBRT and HDR-BT was 4 years (range, 1-14). After a median follow-up of six years from HDR-BT, 9 (52.9%) patients remained free of local recurrence, and 11 (64.7%) were recurrence-free in the treated region. In terms of toxicity, one patient experienced chronic grade 4 genitourinary toxicity requiring cystectomy, but no acute or late gastrointestinal toxicity was observed. At last follow-up, 15 patients (88.2%) were alive.
CONCLUSIONS: In this long-term single-institution series, salvage HDR-BT demonstrates durable local control with acceptable toxicity in patients with local recurrence after prostatectomy and EBRT.
MATERIAL AND METHODS: Patients with local recurrence of prostate adenocarcinoma were retrospectively identified at a single-institution between 2015 and 2024. Recurrence was confirmed by imaging (MRI or choline PET) after prostatectomy and EBRT. Patients had no evidence of distant disease. A total HDR-BT dose of 17 Gy to 20 Gy was administered in two fractions.
RESULTS: Seventeen patients received salvage HDR-BT. The median follow-up time was 74 months (range, 6-100). Twelve patients (70.6%) received salvage-intent EBRT after surgery, while five (29.4%) had adjuvant EBRT. Three patients received androgen deprivation therapy (ADT) concurrently with EBRT in a mean ADT duration of 72 months (range, 6-126). The median time to PSA nadir after EBRT was 14 months. The median interval between EBRT and HDR-BT was 4 years (range, 1-14). After a median follow-up of six years from HDR-BT, 9 (52.9%) patients remained free of local recurrence, and 11 (64.7%) were recurrence-free in the treated region. In terms of toxicity, one patient experienced chronic grade 4 genitourinary toxicity requiring cystectomy, but no acute or late gastrointestinal toxicity was observed. At last follow-up, 15 patients (88.2%) were alive.
CONCLUSIONS: In this long-term single-institution series, salvage HDR-BT demonstrates durable local control with acceptable toxicity in patients with local recurrence after prostatectomy and EBRT.