Purpose:
The incidence of local prostate cancer recurrences after monotherapy with high-dose-rate brachytherapy (HDR-BT) is low. However, a cumulated number of local recurrences during follow-up is naturally observed in highly specialized oncological centers. This retrospective study aimed to present the treatment of local recurrences after HDR-BT with low-dose-rate brachytherapy (LDR-BT).

Material and methods:
Nine patients with low- and intermediate-risk prostate cancer with a median age of 71 years (range, 59-82 years) were diagnosed with local recurrences after previous monotherapy HDR-BT, 3 × 10.5 Gy (from 2010 to 2013). Median time to biochemical recurrence was 59 months (range, 21-80 months). All patients received 145 Gy with salvage LDR-BT (iodine-125). Gastrointestinal and urological toxicities were evaluated based on patients’ records following CTCAE v. 4.0 and IPSS scales.

Results:
The median follow-up after salvage treatment was 30 months (range, 17-63 months). Local recurrences (LR) were detected in two cases, and the actuarial 2-year local control was 88%. Biochemical failure was observed in four cases. Distant metastases (DM) were observed in 2 patients. In one patient, both LR and DM were diagnosed simultaneously. Four patients had no relapse of the disease, and a 2-year disease-free survival (DSF) was 58.3%. Before salvage treatment, median IPSS scores were 6.5 points (range, 1-23 points). At the first follow-up visit, after one month, the mean IPSS score was 20 points, and at the last follow-up visit, it was 8 points (range, 1-26 points). One patient had urinary retention after treatment. There was no significant change in IPSS scores before and after the treatment (p = 0.68). Two patients had grade 1 toxicity in the gastrointestinal tract.

Conclusions:
Salvage LDR-BT for patients with prostate cancer previously treated with HDR-BT monotherapy is characterized by acceptable toxicity, and may result in local disease control.



中文翻译：

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低剂量率碘 125 近距离放射治疗在原发性高剂量率单一疗法后前列腺癌局部复发治疗中的潜力

目的：
高剂量率近距离放疗 (HDR-BT) 单药治疗后局部前列腺癌的复发率很低。然而，在高度专业化的肿瘤中心自然会观察到随访期间局部复发的累积数量。本回顾性研究旨在介绍采用低剂量率近距离放疗 (LDR-BT) 治疗 HDR-BT 后局部复发的情况。

材料与方法：
9 名中位年龄为 71 岁（范围为 59-82 岁）的低危和中危前列腺癌患者在之前接受过 3 × 10.5 Gy 单药 HDR-BT（2010 年至 2013 年）治疗后被诊断为局部复发。生化复发的中位时间为 59 个月（范围 21-80 个月）。所有患者都接受了 145 Gy 的补救 LDR-BT（碘 125）。根据 CTCAE v.4.0 和 IPSS 量表的患者记录评估胃肠道和泌尿系统毒性。

结果：
挽救治疗后的中位随访时间为 30 个月（范围 17-63 个月）。两例检测到局部复发（LR），精算 2 年局部控制率为 88%。在四例中观察到生化失败。在 2 名患者中观察到远处转移 (DM)。一名患者同时诊断出 LR 和 DM。4 名患者没有复发，2 年无病生存率 (DSF) 为 58.3%。挽救治疗前，IPSS 评分中位数为 6.5 分（范围，1-23 分）。一个月后第一次随访时，平均 IPSS 评分为 20 分，最后一次随访时为 8 分（范围，1-26 分）。一名患者在治疗后出现尿潴留。治疗前后 IPSS 评分没有显着变化 (p = 0.68)。

结论：
对于先前接受过 HDR-BT 单一疗法治疗的前列腺癌患者，挽救 LDR-BT 具有可接受的毒性，并可能导致局部疾病控制。