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Second salvage treatment for local recurrence of prostate cancer using high-dose-rate brachytherapy: a case report.

Claren A, Gautier M, Feuillade J, Falk AT, Levi JM - J Contemp Brachytherapy (2015)

Bottom Line: The HDRB showed an advantage on bone irradiation including femoral heads and the volume receiving 0.5 Gy (EQD2 = 1 Gy with α/β = 3).A third local treatment with good tolerance could be a therapeutic option in case of a second local prostate cancer recurrence in order to delay, as long as possible, the chemical castration.Both techniques (HDRB and SRS) seem valid and should be chosen based on the availability and experience in a treatment center.

View Article: PubMed Central - PubMed

Affiliation: Unit of Radiation Oncology.

ABSTRACT

Purpose: Currently, there are no recommendations for the management of a second local recurrence of prostate adenocarcinoma except for the introduction of androgen deprivation therapy (ADT).

Case report: A 69-year-old man underwent a third salvage local treatment with high-dose-rate brachytherapy (HDRB), for a second biochemical relapse for local recurrence. Thirty-five Grays in 5 fractions were delivered on the whole prostate extended to the proximal part of left seminal vesicle. Given the availability of new treatment techniques in our radiation therapy department, a dosimetric comparison between HDRB and stereoatactic radiosurgery (SRS) was performed.

Results: Immediate tolerance of HDRB was acceptable with achievement of prostate specific antigen (PSA) nadir in 24 months (0.03 ng/ml). Observed late toxicities were only grade 2 urinary incontinence. Dosimetric comparison showed a slight advantage on clinical target volume coverage and rectum protection for the SRS. The HDRB showed an advantage on bone irradiation including femoral heads and the volume receiving 0.5 Gy (EQD2 = 1 Gy with α/β = 3).

Conclusions: A third local treatment with good tolerance could be a therapeutic option in case of a second local prostate cancer recurrence in order to delay, as long as possible, the chemical castration. Both techniques (HDRB and SRS) seem valid and should be chosen based on the availability and experience in a treatment center.

No MeSH data available.


Related in: MedlinePlus

Reconstruction from the dosimetric CT-scan of the brachytherapy treatment. Pink: prostate and half of left seminal vesicle. Blue: urethra. Aquamarine: 10 implanted catheters for treatment. Green: canal anal. Brown: rectum
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Figure 0001: Reconstruction from the dosimetric CT-scan of the brachytherapy treatment. Pink: prostate and half of left seminal vesicle. Blue: urethra. Aquamarine: 10 implanted catheters for treatment. Green: canal anal. Brown: rectum

Mentions: Brachytherapy was performed under general anaesthesia after urinary catheterization. Using trans-rectal ultrasound (TRUS) guidance, 10 catheters (Sharp Needles™, Elekta AB, Stockholm, Sweden) were implanted trans-perineally and peri-urethrally through a dedicated template (Fig. 1). Dosimetric CT-scans were performed daily, before each fraction, followed by re-optimization in regards to the risk of catheter migration. Clinical target volume (CTV) consisted in the whole prostate (prostatic volume 5 cc, due to a previous HIFU treatment) extended to the proximal part of left seminal vesicle. Urethra and rectum were considered as organs at risk (OARs) and were delineated. Brachytherapy delivered a total dose of 35 Gy in 5 fractions (7 Gy/fraction) over 5 consecutive days. The equivalent dose α/β = 3 at 2 Gy (EQD2αβ3) was 70 Gy for prostate cancer. Dose constraints for OARs were: Vu115 (percentage of the urethra volume receiving 115% of the prescribed dose) and Vr90 (percentage of the rectum volume receiving 90% of the prescribed dose). Both of them were to be less than 1% of the prescribed dose. Patient was hospitalized 6 days, from the day before the implantation to the day after the last fraction. Needles were removed just after the last fraction, under low sedation. It led to a common macroscopic haematuria managed with bladder irrigation until the bleeding stopped (24 hours). After removal of the urinary catheter and normalization of urinary function, patient was discharged.


Second salvage treatment for local recurrence of prostate cancer using high-dose-rate brachytherapy: a case report.

Claren A, Gautier M, Feuillade J, Falk AT, Levi JM - J Contemp Brachytherapy (2015)

Reconstruction from the dosimetric CT-scan of the brachytherapy treatment. Pink: prostate and half of left seminal vesicle. Blue: urethra. Aquamarine: 10 implanted catheters for treatment. Green: canal anal. Brown: rectum
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499512&req=5

Figure 0001: Reconstruction from the dosimetric CT-scan of the brachytherapy treatment. Pink: prostate and half of left seminal vesicle. Blue: urethra. Aquamarine: 10 implanted catheters for treatment. Green: canal anal. Brown: rectum
Mentions: Brachytherapy was performed under general anaesthesia after urinary catheterization. Using trans-rectal ultrasound (TRUS) guidance, 10 catheters (Sharp Needles™, Elekta AB, Stockholm, Sweden) were implanted trans-perineally and peri-urethrally through a dedicated template (Fig. 1). Dosimetric CT-scans were performed daily, before each fraction, followed by re-optimization in regards to the risk of catheter migration. Clinical target volume (CTV) consisted in the whole prostate (prostatic volume 5 cc, due to a previous HIFU treatment) extended to the proximal part of left seminal vesicle. Urethra and rectum were considered as organs at risk (OARs) and were delineated. Brachytherapy delivered a total dose of 35 Gy in 5 fractions (7 Gy/fraction) over 5 consecutive days. The equivalent dose α/β = 3 at 2 Gy (EQD2αβ3) was 70 Gy for prostate cancer. Dose constraints for OARs were: Vu115 (percentage of the urethra volume receiving 115% of the prescribed dose) and Vr90 (percentage of the rectum volume receiving 90% of the prescribed dose). Both of them were to be less than 1% of the prescribed dose. Patient was hospitalized 6 days, from the day before the implantation to the day after the last fraction. Needles were removed just after the last fraction, under low sedation. It led to a common macroscopic haematuria managed with bladder irrigation until the bleeding stopped (24 hours). After removal of the urinary catheter and normalization of urinary function, patient was discharged.

Bottom Line: The HDRB showed an advantage on bone irradiation including femoral heads and the volume receiving 0.5 Gy (EQD2 = 1 Gy with α/β = 3).A third local treatment with good tolerance could be a therapeutic option in case of a second local prostate cancer recurrence in order to delay, as long as possible, the chemical castration.Both techniques (HDRB and SRS) seem valid and should be chosen based on the availability and experience in a treatment center.

View Article: PubMed Central - PubMed

Affiliation: Unit of Radiation Oncology.

ABSTRACT

Purpose: Currently, there are no recommendations for the management of a second local recurrence of prostate adenocarcinoma except for the introduction of androgen deprivation therapy (ADT).

Case report: A 69-year-old man underwent a third salvage local treatment with high-dose-rate brachytherapy (HDRB), for a second biochemical relapse for local recurrence. Thirty-five Grays in 5 fractions were delivered on the whole prostate extended to the proximal part of left seminal vesicle. Given the availability of new treatment techniques in our radiation therapy department, a dosimetric comparison between HDRB and stereoatactic radiosurgery (SRS) was performed.

Results: Immediate tolerance of HDRB was acceptable with achievement of prostate specific antigen (PSA) nadir in 24 months (0.03 ng/ml). Observed late toxicities were only grade 2 urinary incontinence. Dosimetric comparison showed a slight advantage on clinical target volume coverage and rectum protection for the SRS. The HDRB showed an advantage on bone irradiation including femoral heads and the volume receiving 0.5 Gy (EQD2 = 1 Gy with α/β = 3).

Conclusions: A third local treatment with good tolerance could be a therapeutic option in case of a second local prostate cancer recurrence in order to delay, as long as possible, the chemical castration. Both techniques (HDRB and SRS) seem valid and should be chosen based on the availability and experience in a treatment center.

No MeSH data available.


Related in: MedlinePlus