Maenhout Metha, Peters Max, van Vulpen Marco, Moerland Marinus A, Meijer Richard P, van den Bosch Maurice A A J, Nguyen Paul L, Frank Steven J, van der Voort van Zyp Jochem R N
1 Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands.
2 Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands.
Technol Cancer Res Treat. 2017 Dec;16(6):1194-1201. doi: 10.1177/1533034617741797. Epub 2017 Dec 5.
Whole-gland salvage treatment of radiorecurrent prostate cancer has a high rate of severe toxicity. The standard of care in case of a biochemical recurrence is androgen deprivation treatment, which is associated with morbidity and negative effects on quality of life. A salvage treatment with acceptable toxicity might postpone the start of androgen deprivation treatment, might have a positive influence on the patients' quality of life, and might even be curative. Here, toxicity and biochemical outcome are described after magnetic resonance imaging-guided focal salvage high-dose-rate brachytherapy in patients with radiorecurrent prostate cancer.
Seventeen patients with pathologically proven locally recurrent prostate cancer were treated with focal high-dose-rate brachytherapy in a single 19-Gy fraction using magnetic resonance imaging for treatment guidance. Primary radiotherapy consisted of external beam radiotherapy or low-dose-rate brachytherapy. Tumors were delineated with Ga-68-prostate-specific membrane antigen or F18-choline positron emission tomography in combination with multiparametric magnetic resonance imaging. All patients had a prostate-specific antigen level of less than 10 ng/mL at the time of recurrence and a prostate-specific antigen doubling time of ≥12 months. Toxicity was measured by using the Common Terminology Criteria for Adverse Events version 4.
Eight of 17 patients had follow-up interval of at least 1 year. At a median follow-up interval of 10 months (range 3-40 months), 1 patient experienced a biochemical recurrence according to the Phoenix criteria, and prostate-specific membrane antigen testing revealed that this was due to a distant nodal metastasis. One patient had a grade 3 urethral stricture at 2 years after treatment.
Focal salvage high-dose-rate brachytherapy in patients with radiorecurrent prostate cancer showed grade 3 toxicity in 1 of 17 patients and a distant nodal metastasis in another patient. Whether this treatment option leads to cure in a subset of patients or whether it can successfully postpone androgen deprivation treatment needs further investigation.
放射性复发前列腺癌的全腺体挽救性治疗具有较高的严重毒性发生率。生化复发时的标准治疗是雄激素剥夺治疗，这与发病率及对生活质量的负面影响相关。一种毒性可接受的挽救性治疗可能会推迟雄激素剥夺治疗的开始，可能对患者生活质量产生积极影响，甚至可能具有治愈效果。在此，描述了磁共振成像引导下的局灶性挽救性高剂量率近距离放射治疗放射性复发前列腺癌患者后的毒性及生化结果。
17例经病理证实为局部复发性前列腺癌的患者接受了局灶性高剂量率近距离放射治疗，单次剂量为19 Gy，采用磁共振成像进行治疗引导。初始放疗包括外照射放疗或低剂量率近距离放射治疗。肿瘤通过Ga-68-前列腺特异性膜抗原或F18-胆碱正电子发射断层扫描联合多参数磁共振成像进行勾画。所有患者复发时前列腺特异性抗原水平低于10 ng/mL，前列腺特异性抗原倍增时间≥12个月。使用不良事件通用术语标准第4版测量毒性。
17例患者中有8例随访间隔至少1年。中位随访间隔为10个月（范围3 - 40个月），根据凤凰城标准，1例患者出现生化复发，前列腺特异性膜抗原检测显示这是由于远处淋巴结转移所致。1例患者在治疗后2年出现3级尿道狭窄。
放射性复发前列腺癌患者的局灶性挽救性高剂量率近距离放射治疗在17例患者中有1例出现3级毒性，另1例出现远处淋巴结转移。这种治疗方案是否能治愈部分患者，或者是否能成功推迟雄激素剥夺治疗，需要进一步研究。
