Long-Term Outcome and Toxicity of Salvage Brachytherapy for Local Failure After Initial Radiotherapy for Prostate Cancer
Received 21 April 2009; received in revised form 3 June 2009; accepted 23 June 2009. published online 05 February 2010.
Purpose
To describe long-term outcomes and toxicity after salvage brachytherapy (BT) for local failure after initial radiotherapy for prostate cancer.
Methods and Materials
Between 1994 and 2008, 37 men with local failure after initial prostate radiotherapy (32 external-beam radiation therapy [EBRT] and 5 BT) underwent salvage BT with 103Pd or 125I. Estimates of freedom from biochemical failure (FFbF, Phoenix definition) and cause-specific survival (CSS) were calculated using the Kaplan-Meier method. Toxicities were graded using CTCv3.0.
Results
Median follow-up was 86 months (range, 2–156). The median dose to 90% of the prostate volume was 122 Gy (range, 67–166). The 10-year FFbF and CSS were 54% and 96%, respectively. On univariate analysis, prostate-specific antigen (PSA) >10 ng/mL at initial diagnosis was significantly associated with FFbF (p = 0.01), and there were trends for both age <70 years (p = 0.08) and PSA <6 ng/mL (p = 0.08) at the time of salvage BT. On multivariate analysis, only presalvage PSA <6 ng/mL (p = 0.046) was significantly associated with improved FFbF. There were three Grade 3 toxicities and one Grade 4 toxicity. Pelvic lymph node dissection before salvage BT was the only variable significantly associated with Grade ≥2 toxicity (p = 0.03).
Conclusion
With a median follow-up of 86 months, salvage prostate BT was associated with a 10-year FFbF of 54% and CSS of 96%. Improved FFbF was associated with a presalvage PSA <6 ng/mL. Toxicity was worse in patients who had undergone pelvic lymph node dissection before salvage BT. Careful patient selection for salvage BT may result in improved outcomes and reduced toxicity.
∗Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY
†Department of Urology, Mount Sinai School of Medicine, New York, NY
‡Department of Pathology, Mount Sinai School of Medicine, New York, NY
Reprint requests to: Richard G. Stock, M.D., Department of Radiation Oncology, Box 1236, 1 Gustave L. Levy Place, New York, NY 10029. Tel: (212) 241-7500; Fax: (212) 410-7194
Conflict of interest: N.N. Stone is owner, Prologics LLC; consultant, Nihan Medi-Physics; and consultant; B & K Medical. The authors report no other conflicts of interest.
ABSTRACT