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Early Safety and Efficacy Profile of Homogeneously Dosed Salvage Stereotactic Body Radiotherapy (SBRT) for Intraprostatic Recurrences After Low Dose Rate (LDR) Brachytherapy

  • John Nikitas
    Affiliations
    Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza, Ste B265, Los Angeles, CA, 90025, USA
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  • Minsong Cao
    Affiliations
    Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza, Ste B265, Los Angeles, CA, 90025, USA
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  • Nicholas G. Nickols
    Affiliations
    Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza, Ste B265, Los Angeles, CA, 90025, USA

    Department of Radiation Oncology, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
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  • Luca Valle
    Affiliations
    Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza, Ste B265, Los Angeles, CA, 90025, USA

    Department of Radiation Oncology, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
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  • Michael L. Steinberg
    Affiliations
    Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza, Ste B265, Los Angeles, CA, 90025, USA
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  • Amar U. Kishan
    Correspondence
    Correspondence author
    Affiliations
    Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza, Ste B265, Los Angeles, CA, 90025, USA
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Published:January 17, 2023DOI:https://doi.org/10.1016/j.clgc.2023.01.007

      Highlights

      • We retrospectively analyzed a cohort of 11 patients with a history of prior low dose rate brachytherapy who were treated with homogeneously dosed salvage stereotactic body radiotherapy (SBRT).
      • Three-year progression-free survival was 70.1%, while three-year overall survival was 100%.
      • Late grade 2 and 3 genitourinary toxicity rates were 36.4% and 9.1%, respectively. Late grade 2 and 3 gastrointestinal toxicity rates were 0% and 9.1%, respectively.
      • Homogeneously dosed prostate SBRT can serve as a safe and effective salvage treatment for local recurrences following LDR brachytherapy.

      Abstract

      Introduction

      We set out to evaluate the safety and efficacy of homogeneously dosed salvage stereotactic body radiation therapy (SBRT) for intraprostatic recurrences following low dose rate (LDR) brachytherapy.

      Patients and Methods

      An institutional prostate SBRT database was interrogated for patients treated between January 2018 and December 2021 with salvage SBRT for intraprostatic recurrences who were previously treated with LDR brachytherapy. Patients received 30–34 Gy in 5 fractions to the prostate with a simultaneous integrated boost of 34–37.5 Gy to gross disease. The maximum urethral dose allowed was 34 Gy. Toxicities were graded using Common Terminology Criteria for Adverse Events, version 5.0.

      Results

      11 patients met our study's inclusion criteria with a median follow-up time of 37.9 months (range, 24.3-51.8 months). Median time between LDR brachytherapy and salvage SBRT was 7 years (range, 2-11 years) with a median PSA of 3.15 ng/mL (range, 0.90-9.83) at the time of salvage radiation. All 11 patients were alive at the time of last follow-up. Our 3-year Kaplan-Meier progression-free survival rate was 70.1%. Median time to recurrence was 24.1 months (range, 18.7-29.7 months). Late (≥3 months) grade 1, 2, and 3 urinary toxicity rates were 27.3%, 36.4%, and 9.1%, respectively. Late (≥3 months) grade 1, 2, and 3 gastrointestinal toxicity rates were 18.2%, 0%, and 9.1%, respectively.

      Conclusion

      Homogeneous salvage SBRT to the prostate with urethral dose minimization has a favorable safety and efficacy profile for treating intraprostatic recurrences following LDR brachytherapy. This may represent an ideal form of salvage SBRT for re-irradiation.

      Micro abstract

      We retrospectively analyzed a cohort of 11 patients with a history of prior low dose rate brachytherapy who were treated with homogeneously dosed salvage stereotactic body radiotherapy (SBRT). Three-year progression-free survival and overall survival were 70.1% and 100%, respectively. Late grade 2 and 3 genitourinary toxicity rates were 36.4% and 9.1%, respectively. Homogeneously dosed prostate SBRT can serve as a safe and effective salvage treatment for local recurrences following LDR brachytherapy.

      Keywords

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