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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

Prostate specific antigen (PSA) evolution (ng/ml)
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Figure 0002: Prostate specific antigen (PSA) evolution (ng/ml)

Mentions: Immediate tolerance was acceptable with the macroscopic hematuria managed within the 24 hours after the Folley catheter removal. One month after salvage HDBR, we noticed a nocturnal urinary frequency of 6 per night and dysuria grade 2 according to the Common Terminology Criteria for Adverse Event (CTCAE v4.0) with no grade ≥ 2 digestive toxicities. At 24 months, late toxicities were nocturnal urinary frequency from 4 to 5 per night, urinary incontinence grade 2 with no grade ≥ 2 digestive complication. Regarding sexual abilities, we observed an erectile dysfunction grade 3, which was already present before treatment (the impact of salvage HDRB on sexual function has been difficult to evaluate due to a pre-therapeutic grade 3 erectile dysfunction). Efficacy at 24 months was achieved with a PSA nadir at 0.03 ng/ml without any ADT (Fig. 2).


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)

Prostate specific antigen (PSA) evolution (ng/ml)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Prostate specific antigen (PSA) evolution (ng/ml)
Mentions: Immediate tolerance was acceptable with the macroscopic hematuria managed within the 24 hours after the Folley catheter removal. One month after salvage HDBR, we noticed a nocturnal urinary frequency of 6 per night and dysuria grade 2 according to the Common Terminology Criteria for Adverse Event (CTCAE v4.0) with no grade ≥ 2 digestive toxicities. At 24 months, late toxicities were nocturnal urinary frequency from 4 to 5 per night, urinary incontinence grade 2 with no grade ≥ 2 digestive complication. Regarding sexual abilities, we observed an erectile dysfunction grade 3, which was already present before treatment (the impact of salvage HDRB on sexual function has been difficult to evaluate due to a pre-therapeutic grade 3 erectile dysfunction). Efficacy at 24 months was achieved with a PSA nadir at 0.03 ng/ml without any ADT (Fig. 2).

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