Top

Published in:

01-02-2014 | Original article

Salvage prostate HDR brachytherapy combined with interstitial hyperthermia for local recurrence after radiation therapy failure

Authors: A.M. Kukiełka, M. Hetnał, T. Dąbrowski, T. Walasek, P. Brandys, D. Nahajowski , R. Kudzia, D. Dybek, M. Reinfuss

Published in: Strahlentherapie und Onkologie | Issue 2/2014

Abstract

Purpose

The aim of the present retrospective study is to evaluate toxicity and early clinical outcomes of interstitial hyperthermia (IHT) combined with high-dose rate (HDR) brachytherapy as a salvage treatment in patients with biopsy-confirmed local recurrence of prostate cancer after previous external beam radiotherapy.

Patients and methods

Between September 2008 and March 2013, 25 patients with local recurrence of previously irradiated prostate cancer were treated. The main eligibility criteria for salvage prostate HDR brachytherapy combined with interstitial hyperthermia were biopsy confirmed local recurrence and absence of nodal and distant metastases. All patients were treated with a dose of 30 Gy in 3 fractions at 21-day intervals. We performed 62 hyperthermia procedures out of 75 planned (83 %). The aim of the hyperthermia treatment was to heat the prostate to 41–43 °C for 60 min. Toxicity for the organs of the genitourinary system and rectum was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE, v. 4.03). Determination of subsequent biochemical failure was based on the Phoenix definition (nadir + 2 ng/ml).

Results

The median age was 71 years (range 62–83 years), the median initial PSA level was 16.3 ng/ml (range 6.37–64 ng/ml), and the median salvage PSA level was 2.8 ng/ml (1.044–25.346 ng/ml). The median follow-up was 13 months (range 4–48 months). The combination of HDR brachytherapy and IHT was well tolerated. The most frequent complications were nocturia, weak urine stream, urinary frequency, hematuria, and urgency. Grade 2 rectal hemorrhage was observed in 1 patient. No grade 3 or higher complications were observed. The 2-year Kaplan–Meier estimate of biochemical control after salvage treatment was 74 %. The PSA in 20 patients decreased below the presalvage level, while 11 patients achieved a PSA nadir < 0.5 ng/ml. All patients are still alive. Of the 7 patients who experienced biochemical failure, bone metastases were found in 2 patients.

Conclusion

IHT in combination with salvage HDR brachytherapy is a well tolerated and effective treatment.

Kuban DA, el-Mahdi AM, Schellhammer PF (1989) Prognosis in patients with local recurrence after definitive irradiation for prostatic carcinoma. Cancer 63:2421–2425PubMedCrossRef

D’Amico AV, Whittington R, Malkowicz SB et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974CrossRef

Lee WR, Hanks GE, Hanlon A (1997) Increasing prostate-specific antigen profile following definitive radiation therapy for localized prostate cancer: clinical observations. J Clin Oncol 15:230–238PubMed

Roach M, Hanks G, Thames H et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65(4):965–974PubMedCrossRef

Arrayeh E, Westphalen AC, Kurhanewicz J et al (2012) Does local recurrence of prostate cancer after radiation therapy occur at the site of primary tumor? Results of a longitudinal MRI and MRSI study. Int J Radiat Oncol Biol Phys 82(5):e787–e793PubMedCentralPubMedCrossRef

NCCN Clinical Practice Guidelines in Oncology. Prostate Cancer, version 2.2013. NCCN; 2013. http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed 26 November 2013

Agarwal PK, Sadetsky N, Konety BR et al (2008) Treatment failure after primary and salvage therapy for prostate cancer: likelihood, patterns of care, and outcomes. Cancer 112(2):307–314PubMedCrossRef

Nguyen PL, D’Amico AV, Lee AK et al (2007) Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure: a systematic review of the literature. Cancer 110(7):1417–1427PubMedCrossRef

Ryu S, Brown SL, Kim SH et al (1996) Preferential radiosensitization of human prostatic carcinoma cells by mild hyperthermia. Int J Radiat Oncol Biol Phys 34(1):133–138PubMedCrossRef

10.

Peschke P, Hahn EW, Wolber G et al (1996) Interstitial radiation and hyperthermia in the Dunning R3327 prostate tumour model: therapeutic efficacy depends on radiation dose-rate, sequence and frequency of heating. Int J Radiat Biol 70(5):609–616PubMedCrossRef

11.

Van Vulpen M, De Leeuw AA, Raaymakers BW et al (2004) Radiotherapy and hyperthermia in the treatment of patients with locally advanced prostate cancer: preliminary results. BJU Int 93(1):36–41CrossRef

12.

Maluta S, Dall’Oglio S, Romano M et al (2007) Conformal radiotherapy plus local hyperthermia in patients affected by locally advanced high risk prostate cancer: preliminary results of a prospective phase II study. Int J Hyperthermia 23(5):451–456PubMedCrossRef

13.

Tilly W, Gellermann J, Graf R, Hildebrandt B et al (2005) Regional hyperthermia in conjunction with definitive radiotherapy against recurrent or locally advanced prostate cancer T3 pN0 M0. Strahlenther Onkol 181(1):35–41PubMedCrossRef

14.

Kukiełka AM, Hetnał M, Brandys P et al (2013) Interstitial hyperthermia of the prostate in combination with brachytherapy: an evaluation of feasibility and early tolerance. Strahlenther Onkol 189(6):467–475PubMedCrossRef

15.

Emami B, Stauffer P, Dewhirst MW et al (1991) RTOG quality assurance guidelines for interstitial hyperthermia. Int J Radiat Oncol Biol Phys 20(5):1117–1124PubMedCrossRef

16.

Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_40. Accessed 26 November 2013

17.

Lee B, Shinohara K, Weinberg V et al (2007) High Dose Rate (HDR) brachytherapy salvage for local prostate recurrence after radiotherapy: the UCSF experience. Int J Rad Onc Biol Phys 67(4):1106–1112CrossRef

18.

Chen CP, Weinberg V, Shinohara K et al (2013) Salvage HDR brachytherapy for recurrent prostate cancer after previous definitive radiotherapy: 5-year outcomes. Int J Radiat Oncol Biol Phys 86(2):324–329PubMedCrossRef

19.

Jo Y, Fujii T, Hara R et al (2011) Salvage high-dose-rate brachytherapy for local prostate cancer recurrence after radiotherapy—preliminary results. BJU Int 109:835–839PubMedCrossRef

20.

Tharp M, Hardacre M, Bennett R et al (2008) Prostate high-dose-rate brachytherapy as salvage treatment of local failure after previous external or permanent seed irradiation for prostate cancer. Brachytherapy 7:231–236PubMedCrossRef

21.

Łyczek J, Kawczyńska MM, Garmol M et al (2009) HDR brachytherapy as a solution in recurrences of locally advanced prostate cancer. J Contemp Brachyther 1(2):105–108

22.

Gawkowska-Suwińska M, Fijałkowski M, Białas B et al (2009) Salvage brachytherapy for local recurrences of prostate treated previously with radiotherapy. J Contemp Brachyther 1(4):211–215

23.

Lahmer G, Lotter M, Kreppner S et al (2013) Protocol-based image-guided salvage brachytherapy: early results in patients with local failure of prostate cancer after radiation therapy. Strahlenther Onkol 189(8):668–674PubMedCrossRef

24.

Prionas SD, Kapp DS, Goffinet DR et al (1994) Thermometry of interstitial hyperthermia given as an adjuvant to brachytherapy for the treatment of carcinoma of the prostate. Int J Radiat Oncol Biol Phys 28(1):151–162PubMedCrossRef

25.

Ramey SJ, Marshall DT (2013) Re-irradiation for salvage of prostate cancer failures after primary radiotherapy. World J Urol31:1339–1345

26.

Beyer DC (2003) Brachytherapy for recurrent prostate cancer after radiation therapy. Semin Radiat Oncol 13:158–165PubMedCrossRef

Title: Salvage prostate HDR brachytherapy combined with interstitial hyperthermia for local recurrence after radiation therapy failure
Authors: A.M. Kukiełka
M. Hetnał
T. Dąbrowski
T. Walasek
P. Brandys
D. Nahajowski
R. Kudzia
D. Dybek
M. Reinfuss
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 2/2014
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-013-0486-z

At a glance: The STEP trials

Springer Medicine

Salvage prostate HDR brachytherapy combined with interstitial hyperthermia for local recurrence after radiation therapy failure

Abstract

Purpose

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2014

Berechnungen der „equivalent uniform dose“ zur akzelerierten Teilbrustbestrahlung mit dem MammoSite-Applikator

Whole abdominopelvic radiotherapy in the palliative treatment of pseudomyxoma peritonei

Oxaliplatin and capecitabine concomitant with neoadjuvant radiotherapy and extended to the resting period in high risk locally advanced rectal cancer

Radio-induced apoptosis of peripheral blood CD8 T lymphocytes is a novel prognostic factor for survival in cervical carcinoma patients

Zusatz von Cetuximab zur primären Radiochemotherapie von Ösophaguskarzinomen verursacht schlechteres Gesamtüberleben

Semiautomated volumetric response evaluation as an imaging biomarker in superior sulcus tumors