Prostate high-dose-rate brachytherapy as salvage treatment of local failure after previous external or permanent seed irradiation for prostate cancer.

PURPOSE: To report our results in using high-dose-rate (HDR) brachytherapy for salvage of local-only failure, after either external beam radiation or permanent seed implant. METHODS AND MATERIALS: The data from 7 patients treated with salvage HDR brachytherapy at our institution was retrospectively reviewed. Information was gathered from chart review and prostate HDR specific questionnaires completed at followup visits. RESULTS: All 7 patients had local-only failure defined by transrectal biopsy. Median followup is 58 months (range, 27-63), with a 71% disease-free survival rate; median survival has not yet been reached. Two patients died of metastatic disease. There have been no further local failures. There has been no Grade 3 or higher rectal injuries. Five patients (71%) developed symptomatic urethral strictures; two previous seed failures developed incontinence with urethral necrosis, salvaged by placement of artificial sphincter or continent catheter channel. These results compare favorably to reported results with salvage permanent seed brachytherapy, prostatectomy, and cryotherapy. CONCLUSIONS: HDR brachytherapy as salvage of local-only failure after previous radiation has limited data reported to date. The disease control rates and complications of treatment compare very favorably with those reported using other modalities. This approach merits further investigation.

Prostate high dose rate brachytherapy in a free-standing cancer center setting.

OBJECTIVES: To determine the safety and acute tolerance of performing prostate high dose rate (HDR) brachytherapy in a free-standing cancer center setting, and to report our approach in delivering such treatment. METHODS: Patients treated with prostate HDR from the inception of our program through December 2004 were included. Disease- and treatment-related information was gathered from chart review. Acute side effects were obtained from both chart review and questioning the patient at follow-up visits. RESULTS: A total of 234 patients were treated with 459 HDR needle insertions. Nearly all patients were treated with external beam irradiation, and the majority also received adjuvant hormonal manipulation. There were no adverse events related to transport to the free-standing cancer center. Treatment was well tolerated, with only 3.7% of procedures developing retention requiring catheter placement; 20% of patients reported significant postimplant dysuria, mean duration of any dysuria being 7.5 days. Postimplant retention and length of any dysuria were not found to be related to any of the analyzed factors. Severity of dysuria was found to be related only to timing of external beam. Postimplant retention was more frequent for some physicians, but this finding was not statistically significant. CONCLUSIONS: Prostate HDR brachytherapy can be delivered safely and effectively in an ambulatory free-standing cancer center setting when done by a urology and radiation oncology team working in close conjunction. Treatment combining HDR brachytherapy as described with external beam radiation, with or without androgen manipulation, is well tolerated by the patient.