Premium
Magnetic resonance image‐guided salvage brachytherapy after radiation in select men who initially presented with favorable‐risk prostate cancer
Author(s) -
Nguyen Paul L.,
Chen MingHui,
D'Amico Anthony V.,
Tempany Clare M.,
Steele Graeme S.,
Albert Michele,
Cormack Robert A.,
CarrLocke David L.,
Bleday Ronald,
Suh W. Warren
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22934
Subject(s) - medicine , brachytherapy , prostate cancer , external beam radiotherapy , hazard ratio , magnetic resonance imaging , urology , salvage therapy , radiation therapy , prostate specific antigen , surgery , confidence interval , radiology , cancer , chemotherapy
BACKGROUND. The authors prospectively evaluated the late gastrointestinal (GI) and genitourinary (GU) toxicity and prostate‐specific antigen (PSA) control of magnetic resonance imaging (MRI)‐guided brachytherapy used as salvage for radiation therapy (RT) failure. METHODS. From October 2000 to October 2005, 25 men with a rising PSA level and biopsy‐proven, intraprostatic cancer at least 2 years after initial RT (external beam in 13 men and brachytherapy in 12 men) who had favorable clinical features (Gleason score ≤7, PSA < 10 ng/mL, negative pelvic and bone imaging studies), received MRI‐guided salvage brachytherapy to a minimum peripheral dose of 137 gray on a phase 1/2 protocol. Estimates of toxicity and cancer control were calculated using the Kaplan‐Meier method. RESULTS. The median follow‐up was 47 months. The 4‐year estimate of grade 3 or 4 GI or GU toxicity was 30%, and 13% of patients required a colostomy and/or urostomy to repair a fistula. An interval < 4.5 years between RT courses was associated with both outcomes with a hazard ratio of 12 (95% confidence interval [95% CI], 1.4–100; P = .02) for grade 3 or 4 toxicity and 25 (95% CI, 1.1–529; P = .04) for colostomy and/orurostomy. PSA control (nadir +2 definition) was 70% at 4 years. CONCLUSIONS. The current results indicated that MRI‐guided salvage brachytherapy in men who are selected based on presenting characteristics and postfailure PSA kinetics can achieve high PSA control rates, although complications requiring surgical intervention may occur in 10% to 15% of patients. Prospective randomized studies are needed to characterize the relative cancer control and toxicity after all forms of salvage local therapy. Cancer 2007. © 2007 American Cancer Society.