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• W1988030914 abstract "Thirty percent of patients have locally recurrent PCa after iPPI and can be treated palliatively with hormone therapy (HT) or curatively with cryotherapy, surgery, or brachytherapy (BT). Because (1) exact location of recurrent tumor is generally unknown, (2) iPPI causes volumetric changes over time, and (3) difficulty recreating iPPI isodose coverage, conventional PPI salvage involves the entire prostate (EP), with GI/GU Grade 3+ toxicity ∼30% and ∼13% requiring colostomy/urostomy for fistulas. Our goal was to assess feasibility, control, and toxicity in eligible patients for partial salvage PPI (sPPI) using MRI/MR-spectroscopy and MR deformation. From 8/2003-12/2009, 15 iPPI patients (73% low,27% intermediate risk) had TRUS, MRI/MRS, exclusion of metastases, with biopsy proven recurrence (BPR), also underwent our validated MR expansion algorithm (∼32% mean volume decrease at 5 years) and deformation tool with volumetric change as a function of time to estimate iPPI isodose distribution on current MR images, allowing identification of coincident areas of recurrence with iPPI under-dosage for planning focal sPPI (n = 14 I-125,144 Gy, n = 1 Pd-103, 125 Gy) without HT. sPPI planning mean D90 for CTV (142 Gy) and EP (37 Gy), with mean V100 rectum 0.5% (0.07 cc) and urethra 12% (0.3 cc). PSA was followed through 2/2011. Follow-up time was from sPPI to PSA failure (PSAF; nadir+2.0), BPR, or last date with follow-up PSA. Progression-free survival (PFS) was defined as no evidence of PSAF or BPR. Toxicity was scored using CTCAE v4.0. At time of sPPI (mean age 66 years [57-75], mean PSA [3.2 ng/mL]), 40% had abnormal MRI/S with one (80%) or 2 (20%) BPR foci of disease (Gleason 6 [71%], 7+ [39%]). Median (med) interval between iPPI and sPPI was 69 months (28-132). With med follow-up of 23.3mos (8-88 months), 2patients failed with BPR at 26 and 35 months without metastases; both failures underwent second sPPI (after 11.7/26.4 months, respective PSAs 0.6/0.7). None developed metastases. Estimates of PFS at 2 and 3 years were 100 and 71%. The sPPI PSA nadir was <0.5 (73%), <0.2 (60%), <0.1 (47%). For toxicity of sPPI, n = 2 (13%) had Grade 1 GI toxicity (G1GI), all with pre-existing G1GI from iPPI. Thirty-three percent of the patients had G2GU requiring medication (n = 4) or self-limited catheterization (n = 1). None had G3+ GI/GU, with no fistulas or operative interventions, even after second sPPI. For erectile dysfunction (ED), prior to sPPI, 53% patients required ED medications (EDRX); after sPPI 67% required EDRX and 13% had ED unresponsive to EDRX. MR-guided partial sPPI in highly selected iPPI patients with BPR is feasible with short-term control comparable to EP sPPI with less toxicity. Partial sPPI may offer cure, but longer follow-up is needed to confirm impact on QOL and treatment." @default.
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• W1988030914 date "2011-10-01" @default.
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• W1988030914 title "Feasibility of MR-Guided Partial Permanent Prostate Implant (PPI) Salvage of Localized Recurrence after Initial PPI (iPPI)-treated Prostate Cancer (PCa)" @default.
• W1988030914 doi "https://doi.org/10.1016/j.ijrobp.2011.06.252" @default.
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