Salvage High-Dose-Rate Brachytherapy for Localized Prostate Cancer Recurrence: A Comparative Analysis of 2 Fractionation Schedules-Single-Institution Study of 223 Patients.
4 affiliations
- 1Brachytherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
- 2Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
- 3Department of Systems Biology and Engineering, Silesian University of Technology, Gliwice, Poland.
- 4Radiotherapy Planning Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
Abstract
Salvage high-dose-rate brachytherapy (sHDR-BT) is an effective option for radiorecurrent prostate cancer. This study aimed to compare the efficacy and toxicity of two sHDR-BT fractionation schedules and identify factors associated with treatment outcomes. We retrospectively analyzed 223 patients treated with sHDR-BT between 2008 and 2021. Patients received either 3 × 10 Gy (n = 150) or 2 × 13 Gy (n = 73). Median follow-up was significantly longer in the 3 × 10 Gy group (125 vs 79 months, P < .001). Apart from a higher frequency of high-grade disease (P = .02) and nodal/distant recurrence (P < .001) in the 2 × 13 Gy cohort, baseline characteristics were comparable between the groups. The Kaplan-Meier estimator, log-rank test, and Cox proportional hazards models were used in statistical analysis. In the entire cohort, the 5-year overall survival rate exceeded 75%, and the median biochemical control was 12.6 years. Factors independently associated with worse oncological outcomes included primary International Society of Urological Pathology grade 5, nodal or distant recurrence, castration resistance, and shorter interval from primary therapy to recurrence. Use of androgen deprivation therapy (ADT) reduced the risk of local failure (P = .04). Late genitourinary and gastrointestinal toxicity was acceptable and comparable between the subgroups (P = .6 and P = .4, respectively). In the no-ADT subgroup (n = 83), median overall survival was 113 months, and median ADT-free survival reached 88 months. Regardless of the fractionation schedule, sHDR-BT is an effective option for selected patients with localized, noncastration-resistant recurrence, characterized by relatively low toxicity. Castration resistance and regional or distant metastases strongly limit efficacy. In appropriately selected patients, salvage therapy can substantially delay the initiation of ADT.
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BibTeX
@article{stankiewicz2026salvage,
title = {{Salvage High-Dose-Rate Brachytherapy for Localized Prostate Cancer Recurrence: A Comparative Analysis of 2 Fractionation Schedules-Single-Institution Study of 223 Patients.}},
author = {Magdalena Stankiewicz and Agata Wilk and Marcela Krzempek and Sylwia Kellas-Ślęczka and Marta Szlag and Piotr Wojcieszek},
journal = {Advances in radiation oncology},
year = {2026},
month = sep,
doi = {10.1016/j.adro.2026.102210},
url = {https://europepmc.org/article/MED/42999902},
note = {CC BY},
}
RIS
TY - JOUR
TI - Salvage High-Dose-Rate Brachytherapy for Localized Prostate Cancer Recurrence: A Comparative Analysis of 2 Fractionation Schedules-Single-Institution Study of 223 Patients.
AU - Magdalena Stankiewicz
AU - Agata Wilk
AU - Marcela Krzempek
AU - Sylwia Kellas-Ślęczka
AU - Marta Szlag
AU - Piotr Wojcieszek
PY - 2026
DA - 2026/09/17
JO - Advances in radiation oncology
DO - 10.1016/j.adro.2026.102210
UR - https://europepmc.org/article/MED/42999902
AB - Salvage high-dose-rate brachytherapy (sHDR-BT) is an effective option for radiorecurrent prostate cancer. This study aimed to compare the efficacy and toxicity of two sHDR-BT fractionation schedules and identify factors associated with treatment outcomes. We retrospectively analyzed 223 patients treated with sHDR-BT between 2008 and 2021. Patients received either 3 × 10 Gy (n = 150) or 2 × 13 Gy (n = 73). Median follow-up was significantly longer in the 3 × 10 Gy group (125 vs 79 months, P < .001). Apart from a higher frequency of high-grade disease (P = .02) and nodal/distant recurrence (P < .001) in the 2 × 13 Gy cohort, baseline characteristics were comparable between the groups. The Kaplan-Meier estimator, log-rank test, and Cox proportional hazards models were used in statistical analysis. In the entire cohort, the 5-year overall survival rate exceeded 75%, and the median biochemical control was 12.6 years. Factors independently associated with worse oncological outcomes included primary International Society of Urological Pathology grade 5, nodal or distant recurrence, castration resistance, and shorter interval from primary therapy to recurrence. Use of androgen deprivation therapy (ADT) reduced the risk of local failure (P = .04). Late genitourinary and gastrointestinal toxicity was acceptable and comparable between the subgroups (P = .6 and P = .4, respectively). In the no-ADT subgroup (n = 83), median overall survival was 113 months, and median ADT-free survival reached 88 months. Regardless of the fractionation schedule, sHDR-BT is an effective option for selected patients with localized, noncastration-resistant recurrence, characterized by relatively low toxicity. Castration resistance and regional or distant metastases strongly limit efficacy. In appropriately selected patients, salvage therapy can substantially delay the initiation of ADT.
SN - 2452-1094
ER -