eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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3/2022
vol. 14
 
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abstract:
Original paper

Urinary toxicity after salvage re-irradiation for prostate cancer local failure after definitive radiotherapy: a clinical and dosimetric prognostic factors analysis

Giovanna Dipasquale
1
,
Thomas Zilli
2
,
Claudio Fiorino
3
,
Vérane Achard
4
,
Michel Rouzaud
1
,
Raymond Miralbell
5

1.
Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
2.
Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland, Geneva University Faculty of Medicine, Geneva Switzerland
3.
Medical Physics San Raffaele Scientific Institute, Milan, Italy
4.
Division of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland, Geneva University Faculty of Medicine, Geneva, Switzerland
5.
Geneva University Faculty of Medicine, Geneva, Switzerland
J Contemp Brachytherapy 2022; 14, 3: 222-226
Online publish date: 2022/06/14
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Purpose
Predictors of long-term toxicity after prostate cancer re-irradiation are scarce. In this study, we retrospectively assessed the impact of clinical/dosimetric data on late genitourinary (GU) toxicity on fourteen radio-recurrent prostate cancer patients treated with salvage radiotherapy (RT).

Material and methods
To identify dose parameters and clinical factors potentially associated to severe long-term GU toxicity, study population was stratified in two groups according to toxicity, including one low-grade group (grade ≤ 2, n = 6) and one high-grade group (grade ≥ 3, n = 8). Dose prescription at primary and salvage-RT in 2 Gy equivalent dose (EQD2Gy) per fraction, treatment techniques, and clinical factors potentially associated to severe GU toxicity were analyzed.

Results
At salvage-RT, the median EQD2Gy / = 3 Gy was significantly higher in the high-toxicity group (85 Gy, range, 71-85 Gy) compared to the low-toxicity group (77 Gy, range, 61-85 Gy) (p = 0.01). All patients treated using salvage-RT with a brachytherapy (BT) boost and with a baseline Framingham risk-score of > 20% (n = 8) developed severe GU toxicity, while none of the remaining patients developed a grade 3 or more GU toxicity (p = 0.0003). V70 > 0 and V75 > 0 of the primary treatment were associated with an increased rate of toxicity.

Conclusions
Our analysis shows that the delivery of doses up to 75-80 Gy (EQD2Gy, / = 3 Gy) in salvage-RT can be safe in terms of severe GU toxicity avoidance. Furthermore, concomitant cardiovascular comorbidities seem to increase the risk to develop severe GU toxicity.

keywords:

prostate cancer, prognostic factors, re-irradiation, urinary toxicity

 
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