Pons-Llanas O, Burgos-Burgos J, Roldan-Ortega S, Conde-Moreno A, Celada-Alvarez F, Ruiz-Martinez J C, Lliso-Valverde F, Tormo-Micó A, Perez-Calatayud J, López-Torrecilla J
Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia Spain.
Radiotherapy Department, Hospital, Las Palmas de Gran Canaria, Spain.
Rep Pract Oncol Radiother. 2020 Sep-Oct;25(5):754-759. doi: 10.1016/j.rpor.2020.06.010. Epub 2020 Jul 5.
Retrospective, single-institution analysis of clinical outcomes and treatment-related toxicity in patients treated with salvage I-125 low-dose rate (LDR) brachytherapy (BT) for locally-recurrent prostate cancer after radiotherapy.
Between 2008 and 2018, 30 patients with biopsy-confirmed prostate cancer recurrence underwent salvage treatment with I-125 LDR-BT. Of these 30 patients, 14 were previously treated with primary external beam radiotherapy (EBRT; median dose, 73 Gy) and 16 with primary I-125 LDR-BT (145 Gy and 160 Gy in 14 and 2 cases, respectively). At seed implantation, the mean age was 75.8 years, with a median Gleason score of 7 and pre-salvage PSA of <10 ng/mL. Six patients received androgen deprivation therapy for six months after relapse diagnosis. The prescribed salvage I-125 BT dose to the gland was 120-130 Gy, with dose restrictions of Dmax <135% (urethra) and <100% (rectum). Toxicity was evaluated according to the CTCAE scale (v4.0).
At a median follow-up of 45 months, the biochemical recurrence-free survival rates at 1, 3 and 5 years were 86.7%, 56.7% and 53.3%, respectively. Overall survival at 5 years was 87%. On the multivariate analysis, two variables were significant predictors of recurrence: PSA at relapse and nadir PSA post-salvage. Grade 3 genitourinary toxicity was observed in 5 patients (radiation-induced cystitis in 3 cases and urethral stenosis in 2) and G3 gastrointestinal toxicity in 3 patients (rectal bleeding).
Salvage therapy with I-125 brachytherapy is a safe and effective treatment option for locally-recurrent prostate cancer in previously-irradiated patients. High pre-salvage PSA and post-salvage nadir PSA values were significantly associated with a worse disease control after salvage I-125 LDR-BT. In well-selected patients, I-125 LDR-BT is comparable to other salvage therapies in terms of disease control and toxicity. However, more research is needed to determine the optimal management of locally-recurrent prostate cancer.
对接受挽救性碘-125低剂量率（LDR）近距离放射治疗（BT）的局部复发性前列腺癌患者的临床结局和治疗相关毒性进行回顾性单机构分析。
2008年至2018年期间，30例经活检确诊为前列腺癌复发的患者接受了碘-125 LDR-BT挽救性治疗。在这30例患者中，14例先前接受过原发性外照射放疗（EBRT；中位剂量73 Gy），16例先前接受过原发性碘-125 LDR-BT（14例剂量为145 Gy，2例为160 Gy）。植入粒子时，平均年龄为75.8岁，中位Gleason评分为7分，挽救前前列腺特异性抗原（PSA）<10 ng/mL。6例患者在复发诊断后接受了6个月的雄激素剥夺治疗。规定的腺体挽救性碘-125 BT剂量为120 - 130 Gy，剂量限制为Dmax<135%（尿道）和<100%（直肠）。根据美国国立癌症研究所常见不良反应事件评价标准（CTCAE，第4.0版）评估毒性。
中位随访45个月时，1年、3年和5年的无生化复发生存率分别为86.7%、56.7%和53.3%。5年总生存率为87%。多因素分析显示，两个变量是复发的显著预测因素：复发时的PSA和挽救后PSA最低点。5例患者出现3级泌尿生殖系统毒性（3例为放射性膀胱炎，2例为尿道狭窄），3例患者出现3级胃肠道毒性（直肠出血）。
碘-125近距离放射治疗挽救性治疗是先前接受过放疗的局部复发性前列腺癌患者的一种安全有效的治疗选择。挽救前PSA高值和挽救后PSA最低点值与碘-125 LDR-BT挽救性治疗后较差的疾病控制显著相关。在精心挑选的患者中，碘-125 LDR-BT在疾病控制和毒性方面与其他挽救性治疗相当。然而，需要更多研究来确定局部复发性前列腺癌的最佳管理方案。
