What is appropriate local salvage therapy after prostate brachytherapy failure?
If salvage EBRT - what dose?
Answer from: Radiation Oncologist at Academic Institution
I would not re-irradiate the prostate using EBRT. I would only use HDR brachytherapy. I would give 6Gy x 6 /2 implants based on our published experience. Alternative fractionation is 8Gy x 4 based MSKCC study. There is also data on permanent seed salvage. That is mostly...
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Answer from: Radiation Oncologist at Community Practice
I agree with @Drew Moghanaki's excellent comments. I add the following1. reference to a recently published paper from our institution exploring the subject: https://www.ncbi.nlm.nih.gov/pubmed/27693225Dr. Kwok reports 3yr BFFS 69% with 2/11 pts with grade 3 toxicity2. mpMRI may be obscured by seed c...
Answer from: Radiation Oncologist at Community Practice
The nice people who use this website sure do keep coming up with some challenging questions. As such, we once again consider a dilemma without much evidence to guide us - similar to cases reviewed in the Red Journal Gray Zone. Of course, start with an H&P and follow basic oncologic principles. T...
Answer from: Radiation Oncologist at Academic Institution
To my knowledge the largest series is from Dr Hsu. He already answered here. Fifty two patients with only a single case of Grade 3 toxicity with a 6 fraction x 6 Gy over 2 implants (https://www.ncbi.nlm.nih.gov/pubmed/23474112)The other relevant publication is the prospective trial from Dr Yamada wi...