Focal salvage high-dose-rate brachytherapy with implantable rectum spacer for locally recurrent prostate cancer after initial low-dose-rate with grade 3 rectal toxicity

Thirza Opbroek; Anne Cobussen; Evert J Van Limbergen; Ben G L Vanneste

doi:10.5114/jcb.2023.126051

Focal salvage high-dose-rate brachytherapy with implantable rectum spacer for locally recurrent prostate cancer after initial low-dose-rate with grade 3 rectal toxicity

J Contemp Brachytherapy. 2023 Apr;15(2):154-158. doi: 10.5114/jcb.2023.126051. Epub 2023 Mar 22.

Authors

Thirza Opbroek¹, Anne Cobussen¹, Evert J Van Limbergen¹, Ben G L Vanneste^{1

2}

Affiliations

¹ Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
² Department of Human Structure and Repair, Department of Radiation Oncology, Ghent University Hospital, Belgium.

Abstract

Purpose: Locally recurrent prostate cancer after previous radiation therapy remains challenging. One of the curative options for these patients is salvage brachytherapy. There are no reports available on the use of a biodegradable rectal balloon implantation (RBI) in combination with brachytherapy in patients with recurrent prostate cancer after previous radiotherapy.

Case presentation: Here, we report on a patient with a local recurrence at five years after previous low-dose-rate brachytherapy with a prescribed dose of 145 Gray (Gy) for a low-risk prostate adenocarcinoma. The patient experienced grade 3 rectal toxicity, which was resolved at the time of local recurrence. He was treated with focal high-dose-rate (HDR) brachytherapy of 2 fr. × 13 Gy after RBI implantation. Four years post-salvage treatment, there was no evidence of biochemical recurrence according Phoenix definition, and no gastro-intestinal or genitourinary toxicity.

Conclusions: This case describes the use of RBI implantation in combination with a focal salvage HDR in a patient with recurrent disease, with significant initial grade 3 rectal toxicity after previous irradiation. The use of a biodegradable RBI proved to be a promising solution for such a patient; however, this method needs to be further investigated.

Keywords: brachytherapy; prostate cancer; rectal balloon implant; salvage therapy.

Publication types

Case Reports