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2018 ; 7
(3
): 414-435
Nephropedia Template TP
gab.com Text
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English Wikipedia
The role of salvage brachytherapy for local relapse after external beam
radiotherapy for prostate cancer
#MMPMID30050801
Tisseverasinghe SA
; Crook JM
Transl Androl Urol
2018[Jun]; 7
(3
): 414-435
PMID30050801
show ga
Prostate cancer is the most prevalent cancer amongst men. For localized disease,
there currently exist several reliable treatment modalities including surgery,
radiotherapy and brachytherapy. Our growing understanding of this disease
indicates that local control plays a very important role in prevention of
subsequent dissemination. Many improvements to external beam radiotherapy over
recent years have decreased toxicity and improved outcomes, but nonetheless,
local relapse remains common. Many salvage options exist for locally recurrent
prostate cancer, but are rarely offered, partly because of the fear of toxicity.
Many men with isolated local recurrence therefore do not receive potentially
curative second line treatment and are instead treated with palliative androgen
suppression. Selection plays an important role in determining which individuals
are likely to benefit from salvage. Those at high risk of pre-existing
micro-metastatic disease despite negative staging scans are unlikely to benefit.
Prostate brachytherapy has evolved over the more than 3 decades of experience.
Modern techniques allow more precise tumor localization and dose delivery. Better
understanding of dosimetric parameters can distinguish optimal from suboptimal
implants. Salvage brachytherapy can be an effective treatment for locally
recurrent prostate cancer after prior external beam radiotherapy. We review the
literature pertaining to both low dose rate (LDR) and high dose rate (HDR)
salvage brachytherapy and discuss patient selection, optimal dose, treatment
volume and toxicity avoidance.