Introduction
Material and methods
Patients’ selection
Follow-up after primary radiation
Salvage radiation modalities
Stereotactic body radiation therapy protocol
High dose rate brachytherapy protocol
Androgen deprivation therapy (ADT)
Follow-up after salvage radiation and endpoints’ definitions
Statistical analyses
Results
Patients’ characteristics
Characteristics | High-dose-rate brachytherapy (n = 10) | Stereotactic body radiation therapy (n = 18) |
p value |
p value | ||
---|---|---|---|---|---|---|
Primary treatment (%) | Recurrence (%) | Primary treatment (%) | Recurrence (%) | Primary | Recurrence | |
Age (years, median, IQR) | 63 (58–68) | 69 (65–77) | 62 (58–66) | 69 (64–75) | 0.87 | 0.85 |
PSA at the time of treatment (ng/mL, median, IQR) | 26 (8.6–47) | 4.37 (2.01–4.76) | 6.6 (5.7–9.2) | 4.5 (3.0–6.3) | 0.0046 | 0.43 |
Initial T stage | - | - | 0.005 | |||
T1c | 2 (20.0) | 12 (66.7) | ||||
T2a | 2 (20.0) | 2 (11.1) | ||||
T3 | 6 (60.0) | 2 (11.1) | ||||
Not evaluated | - | 2 (11.1) | ||||
Initial Gleason sum | 0.04 | 0.71 | ||||
Gleason 6 or less | 2 (20.0) | 1 (10.0) | 13 (72.2) | 2 (11.1) | ||
Gleason 7 | 4 (40.0) | 2 (20.0) | 4 (22.2) | 2 (11.1) | ||
Gleason 8 | 4 (40.0) | 1 (10.0) | 1 (5.6) | 1 (5.6) | ||
Gleason 9 | - | 2 (20.0) | - | 2 (11.1) | ||
Not evaluated | - | 4 (40.0) | - | 11 (61.1) | ||
D’Amico risk group | 0.006 | |||||
Low | 1 (10.0) | - | 10 (55.6) | - | ||
Intermediate | 2 (20.0) | 5 (27.8) | ||||
High | 7 (70.0) | 2 (11.1) | ||||
Not evaluated | - | 1 (5.6) | ||||
Tumor localization | 0.21 | 0.019 | ||||
Apex | - | 1 (10.0) | - | |||
Median | - | - | 2 (11.1) | 2 (11.1) | ||
Basis | - | 3 (30.0) | 1 (5.6) | 1 (5.6) | ||
Seminal vesical | 1 (10.0) | - | - | 7 (38.9) | ||
More than 1 location | 1 (10.0) | 6 (60.0) | 3 (16.7) | 3 (16.7) | ||
Not evaluated | 8 (80.0) | 1 (10.0) | 12 (66.7) | 4 (22.2) | ||
Initial ADT duration | - | - | 0.0031 | |||
Short (6 months) | 2 (20.0) | 7 (38.9) | ||||
Long (24–36 months) | 5 (50.0) | 1 (5.6) | ||||
No ADT | 3 (30.0) | 10 (55.6) | ||||
ADT at recurrence | - | - | 0.05 | |||
Yes | 2 (20.0) | 10 (55.6) | ||||
No | 8 (80.0) | 8 (44.4) | ||||
ADT duration (months, median, IQR) | - | 63.5 (48–79) | - | 15 (6–21) | 0.028 | |
Initial radiation modality | - | - | <0.001 | |||
LDR brachytherapy | 1 (10.0) | 15 (83.3) | ||||
EBRT w/o pelvic radiation | 5 (50.0) | 3 (16.7)- | ||||
EBRT with pelvic radiation | 4 (40.0) | |||||
Prostate volume (cc, median, IQR) | 33.5 (32–35) | 35 (20–50) | 35 (25–44.5) | 26 (22.5–28.5) | 0.78 | 0.59 |
PSA nadir (ng/mL, median, IQR) | 0.065 (0.01–0.2) | 0.66 (0.23–1.13) | 0.58 (0.34–1.05) | 0.89 (0.29–1.4) | 0.0034 | 0.97 |
Time to PSA nadir (months, median, IQR) | 21 (16–30) | 6 (5–8) | 28 (11–35) | 7.5 (4.5–10) | 0.79 | 0.89 |
Time to biological recurrence (months, median, IQR) | 69 (55–85) | 13 (10–26) | 49 (37–70) | 5.5 (4–6) | 0.11 | 0.0347 |
Time to salvage treatment (months, median, IQR) | 86.5 (66–108) | - | 77 (64–92) | - | 0.26 |
Oncologic outcomes after salvage high-dose-rate brachytherapy
a | |||
Parameter | Value | ||
CTV | 35 (25–43) | ||
D90 | 106 (106–108) | ||
D100 | 81 (77–85) | ||
V100 | 97 (96–98) | ||
V150 | 24 (22–32) | ||
V200 | 8 (7–10) | ||
D2 rectum | 57 (50–69) | ||
D2 urethra | 81 (76–85) | ||
DHI | 0.27 (0.22–0.33) | ||
b | |||
Region of interest | Mean (cGy) | Min (cGy) | Max (cGy) |
GTV | 4027 | 3462 | 4375 |
PTV | 3936 | 3134 | 4375 |
Bladder | 862 | 161 | 3680 |
Rectum | 727 | 102 | 3561 |
Right femoral head | 371 | 145 | 894 |
Left femoral head | 428 | 139 | 1075 |
Oncologic outcomes after salvage stereotactic body radiation therapy
Toxicities after salvage radiation
a | ||||
HDRB | At baseline | Maximal acute toxicity | Maximal late toxicity | At last follow-up |
Urinary complication (n, %) | ||||
No complication | 5 (50.0) | - | 2 (20.0) | 2 (20.0) |
Grade 1 | 4 (40.0) | 2 (20.0) | - | 3 (30.0) |
Grade 2 | 1 (10.0) | 7 (70.0) | 6 (60.0) | 5 (50.0) |
Grade 3 | - | - | 1 (10.0) | - |
Grade 4 | - | - | - | - |
Not evaluated | 1 (10.0) | 1 (10.0) | - | |
Digestive complication (n, %) | ||||
No complication | 7 (70.0) | 8 (80.0) | 7 (70.0) | 10 (100.0) |
Grade 1 | 3 (30.0) | 1 (10.0) | 2 (20.0) | - |
Grade 2 | - | - | - | - |
Grade 3 | - | - | - | - |
Grade 4 | - | - | - | - |
Not evaluated | - | 1 (10.0) | 1 (10.0) | - |
b | ||||
HDRB | At 3 months | At last follow-up | ||
n | % | n | % | |
Urinary complication | ||||
No modification | 2 | 20.0 | 4 | 40.0 |
+ 1 grade | 3 | 30.0 | 5 | 50.0 |
+ 2 grades | 4 | 40.0 | 1 | 10.0 |
Not evaluated | 1 | 10.0 | - | - |
Digestive complication | ||||
No modification | 9 | 90.0% | 10 | 100 |
+ 1 grade | - | - | - | - |
+ 2 grades | - | - | - | - |
Not evaluated | 1 | 10.0% | - | - |
c | ||||
SBRT | At baseline | Maximal acute toxicity | Maximal late toxicity | At last follow-up |
Urinary complication (n, %) | ||||
No complication | 8 (44.4) | 2 (11.1) | 6 (33.3) | 4 (22.2) |
Grade 1 | 5 (27.8) | 5 (27.8) | 4 (22.2) | 6 (33.3) |
Grade 2 | 3 (16.7) | 2 (11.1) | 1 (5.6) | 3 (16.7) |
Grade 3 | 1 (5.6) | - | - | - |
Grade 4 | - | - | 1 (5.6) | - |
Not evaluated | 1 (5.6) | 9 (50.0) | 6 (33.3) | 5 (27.8) |
Digestive complication (n, %) | ||||
No complication | 13 (72.2) | 5 (27.8) | 9 (50.0) | 10 (55.6) |
Grade 1 | 1 (5.6) | 1 (5.6) | - | 1 (5.6) |
Grade 2 | 2 (11.1) | 2 (11.1) | 1 (5.6) | 2 (11.1) |
Grade 3 | - | - | - | - |
Grade 4 | - | - | - | - |
Not evaluated | 2 (11.1) | 10 (55.6) | 8 (44.4) | 5 (27.8) |
d | ||||
SBRT | At 3 months | At last follow-up | ||
n | % | n | % | |
Urinary complication | ||||
No modification | 4 | 22.3 | 12 | 66.7 |
+ 1 grade | 4 | 22.2 | 1 | 5.6 |
+ 2 grades | 1 | 5.6 | - | - |
Not evaluated | 9 | 50.0 | 5 | 27.8 |
Digestive complication | ||||
No modification | 7 | 38.9 | 12 | 66.7 |
+ 1 grade | - | - | - | - |
+ 2 grades | 1 | 5.6 | - | - |
Not evaluated | 10 | 55.6 | 6 | 33.3 |