Salvage brachytherapy for locally recurrent prostate cancer after definitive radiotherapy – a multicentric French cohort by the SFRO brachytherapy group

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-30 DOI:10.1016/j.radonc.2025.111170

M. Kissel , K. Ka , Y. Meraouna , M. Terlizzi , R. Schiappa , J-M. Hannoun-Levi , S. Hanaya , A-A. Serre , O. Sarr , C. Verry , A. Khoukaz , E. Martin , J-M. Cosset , P. Blanchard

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Abstract

Background and purpose

Salvage brachytherapy (BT) after definitive irradiation for prostate cancer is gaining increasing interest, although many areas of uncertainty remain.

Materials and methods

We established a large national retrospective cohort including all patients treated with salvage prostate BT for isolated prostatic local relapse after definitive radiotherapy between 2006 and 2022 in seven French expert centers.

Results

A total of 266 patients were included. At initial diagnosis, 42 % of patients presented with high-risk disease. Primary irradiation consisted of external beam radiotherapy (EBRT) in 78 % of cases, most commonly delivered with a 3D conformal technique (51 %), with a median dose of 74 Gy. Median PSA at relapse was 3.7 ng/mL. Salvage BT was performed using low-dose-rate (LDR) permanent iodine seed implantation in 63 % of patients and high-dose-rate (HDR) brachytherapy in 37 %. Seventy percent of patients were treated with whole-gland irradiation, while the remainder received a focal approach. In 34.5 % of cases, androgen deprivation therapy (ADT) was combined with salvage BT. After a median follow-up of 60.1 months, 135 (50.7 %) of patients experienced biochemical relapse. Median biochemical progression-free survival (bPFS) was 40.0 months. On multivariate analysis, initial risk group (high-risk: HR = 1.64, 95 % CI [1.13–2.37], p = 0.008), BT technique (HDR: HR = 2.14, 95 % CI [1.41–3.26], p = 0.0004), and treated volume (focal vs. whole-gland: HR = 2.14, 95 % CI [1.23–3.73], p = 0.007) were significantly associated with bPFS. Late grade 3 gastrointestinal and genitourinary toxicities occurred in 3 % and 14 % of patients, respectively.

Conclusion

Salvage BT provides encouraging disease control with an acceptable toxicity profile. Careful patient selection remains essential.

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晚期放射治疗后局部复发前列腺癌的补救性近距离治疗-一项由SFRO近距离治疗组进行的多中心法国队列研究。

背景和目的：前列腺癌明确照射后的补救性近距离治疗（BT）越来越受到人们的关注，尽管许多领域仍存在不确定性。材料和方法：我们建立了一个大型的国家回顾性队列，包括2006年至2022年间在法国7个专家中心接受补救性前列腺BT治疗孤立性前列腺局部复发的所有患者。结果：共纳入266例患者。在最初诊断时，42% %的患者表现为高危疾病。78 %的病例的一次照射包括外束放疗（EBRT），最常见的是三维适形技术（51 %），中位剂量为74 Gy。复发时中位PSA为3.7 ng/mL。63 %的患者采用低剂量率（LDR）永久性碘粒子植入治疗，37 %的患者采用高剂量率（HDR）近距离治疗。70%的患者接受全腺体放射治疗，其余患者接受局灶放射治疗。在34.5% %的病例中，雄激素剥夺治疗（ADT）与补救性BT联合使用，中位随访60.1 个月后，135例（50.7 %）患者出现生化复发。中位无生化进展生存期（bPFS）为40.0 个月。在多变量分析,初始风险集团(高风险:人力资源 = 1.64,95年 % CI [1.13 - -2.37], p = 0.008),英国电信技术(HDR:人力资源 = 2.14,95年 % CI [1.41 - -3.26], p = 0.0004),和治疗量(焦与whole-gland:人力资源 = 2.14,95 % CI [1.23 - -3.73], p = 0.007)与带通滤波器显著相关。晚期3级胃肠道和泌尿生殖系统毒性分别发生在3 %和14 %的患者中。结论：补救性BT提供了令人鼓舞的疾病控制和可接受的毒性特征。仔细选择病人仍然是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.