This prospective study of HDR salvage

monotherapy demonstrates that it is an effective and well-tolerated treatment paradigm for patients who develop locally recurrent prostate cancer EBRT. HDR brachytherapy should be considered in the local management of recurrent prostate cancer, even in patients who have been previously heavily treated with ultra-high-dose EBRT. “
“One of the critical elements that have led to improved outcomes for intermediate-risk prostate cancer patients is the use of dose escalation [1], [2], [3], [4], [5], [6] and [7]. A meta-analysis of the seven randomized dose-escalated trials has demonstrated a biochemical control benefit for intermediate-risk patients with increasing biologically effective doses (BEDs) (5). Viani et al. found that a near linear benefit was evident with escalation selleck compound of the radiation dose, and there was no sign that the dose effect had reached a plateau with further escalation of the radiation dose; these studies included BED of up to 175 Gy. In addition, Levegrun et al. (8) have used posttreatment biopsies to represent local control and suggested a TCP50 of 70.5 Gy (BED of 155 Gy) and near linear tumor control improvements with doses approaching 85 Gy (BED

of 187 Gy). Current therapy for intermediate-risk patients with dose-escalated external beam radiation therapy (EBRT) plus androgen deprivation therapy

[9] and [10] result in 10-year actuarial biochemical PD-1 inhibiton failure rates of 20–25% and local failure rates of 15–25% [11] and [12]. As seen in Table 1, most brachytherapy implant alone series result in 10-year actuarial biochemical failure rates of greater than 20% for intermediate-risk patients. Clearly, intermediate-risk prostate cancer is not uniformly eradicated Cytidine deaminase with BEDs of brachytherapy implant or dose-escalated EBRT alone (BED of 150–190 Gy) and warrants more aggressive therapy. Supplemental EBRT is one of the most reliable and consistent ways for safely escalating radiation dose levels in conjunction with brachytherapy to facilitate the delivery of higher BED levels within the prostate and the extraprostatic tissue. Using BED models published by Stock et al. (13) (using α/β of 2.0), 125I monotherapy implant prescription of 144 Gy has a BED of approximately 160 Gy based on the D90 coverage; however, combination therapy with 110 Gy of 125I implant and 50.4 Gy of supplementary EBRT yields a BED of approximately 230 Gy. This marked difference in BED has been shown to correlate with improved biochemical and local control. Stone et al.