Pavlov, A. Y., Dzidzariya, A. G., Tsybulskiy, A., & Mirzakhanov, R. I. (2023). Salvage Radiotherapy and Androgen-Deprivation Therapy for Local Recurrence of Prostate Cancer after Radical Prostatectomy. Voprosy Onkologii, 69(5), 876–884. https://doi.org/10.37469/0507-3758-2023-69-5-876-884

Abstract

Relevance. Patients with biochemical recurrence of prostate cancer (prostate cancer) after radical prostatectomy (RP) comprise a complex and heterogeneous group. This article is devoted to the choice of therapeutic strategies for the local recurrence of prostate cancer after RPE.

Purpose. To evaluate the clinical efficacy and analyse the complications and quality of life after performing life-saving high-power brachytherapy in mono mode, remote radiation therapy, and androgen deprivation therapy for local recurrence of prostate cancer after RP.

Material and methods. From January 2016 to December 2020, 60 patients with local recurrence of prostate cancer after RP were treated at the FSBI "RNCRR" of the Ministry of Health of the Russian Federation. 2 groups were identified: group I included 30 patients who underwent salvage external beam radiation therapy (EBRT) in the mode of classical fractionation; group II, within the framework of the scientific protocol, 30 patients underwent 2 fractions of salvage HDR brachytherapy from 15 Gy to SOD 30 Gy. Additionally, a group of 3 patients who underwent hormone therapy without radiation on the basis of the oncological dispensary No. 4. All patients underwent pelvic MRI and PET-CT with prostate-specific membrane antigen (PSMA) ligands, and a biopsy of the bed of the removed prostate gland by perineal access was also performed in group 2. General and biochemical relapse-free survival, as well as the structure of early and late radiation complications, were analysed.

Results. The overall survival rate was 100%. The values of 1-year, 2-year and 3-year relapse-free survival in the group of life-saving EBRT were 96.7%, 83.3% and 76.7%, and in the group of life-saving brachytherapy – 100%, 93,3 %, 89,4 %. A comparative analysis of the PSA-specific relapse-free survival showed a tendency to increase in the brachytherapy group. (p = 0,075). Salvage EBRT was more toxic than SBT-HDR. A comparative assessment of radiation toxic reactions revealed a higher frequency of early genitourinary toxicity of grade I and intestinal toxicity of grade I and II in the salvage EBRT group than in the salvage brachytherapy group, as well as late gastrointestinal toxicity of grade I and II.

Conclusions. When comparing the two technologies of life-saving radiation therapy, equivalent efficacy was shown in terms of 3-year general and PSA-specific relapse-free survival; however, at the same time, the technology of life-saving high-dose brachytherapy significantly reduced both early and late genitourinary and gastrointestinal toxicity, which statistically and clinically significantly affects the quality of life.

https://doi.org/10.37469/0507-3758-2023-69-5-876-884

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