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Definition |
Following local recurrence after previous definitive RT there is no indication for external beam salvage RT as the total dose is limited and therefore the chance of cure is low. For carefully selected patients with primary localised PCa and histologically proven local recurrence, high- or low-dose rate (H/LDR) brachytherapy remain effective treatment options with an acceptable toxicity profile. However, the published series are relatively small, therefore this treatment should be offered in experienced centres only. Fifty-two patients were treated at the Scripps Clinic with HDR-brachytherapy over a period of nine years. With a median followup of 60 months the 5-year biochemical control was 51% and only 2% grade 3 GU toxicities were reported.Comparable with these data, 42 patients were treated in a phase-II-trial at MSCCC in New York. Ofnote, the median pre-treatment dose was 81 Gy given with IMRT and the prescription HDR-dose of 32 Gy was delivered in four fractions over 30 hours. The biochemical relapse-free survival after 5 years was 69%(median follow-up 36 months). Grade 2 late side effects were seen in 15% and one patient developed Grade 3 incontinence. However, older data with higher rates of side effects have been reported.
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