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What can be done if seeds fail?

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Posted 4/26/2016 6:57 PM (GMT 0)
The quick answer is - plant more seeds! A study from the University of Kentucky found that about half of such failures could be redeemed by implanting more seeds where there were gaps (cold spots) in the original placement. This once again highlights the importance of perfect seed placement, and follow-up CT scan. They didn't even use a biopsy or advanced imaging to make sure the recurrence was local only.

At UCSF, they used MRI-guided biopsies to assure better patient selection and 63% were progression-free 3 years after re-treatment. Their results would have been even better had they used an advanced PET scan to search for small metastases.

Surgery, ablation, SBRT and focal HDR brachytherapy are options as well.

Salvage low-dose-rate brachytherapy (LDRBT) after primary LDRBT failure

- Allen
Posted 4/27/2016 2:33 AM (GMT 0)
TA: Intetesting that all intermediate guys hit a second recurrence if I am reading this correctly. Is this because of undetected or detected EPE?
Posted 4/27/2016 6:09 AM (GMT 0)
browntrout-

Possibly so. Undoubtedly it had already metastasized in some cases before re-seeding. Possibly more of them should have had EBRT with their original brachytherapy (it looks like about half of them did). It seems there was a lot of poor seed placement (this is why I always say it's so important to have it done by one of the real experts -- it's an art), and possibly, it wasn't checked after 30 days (not all seeds can be stranded, and even stranded seeds shift, and there's the problem of edema).

- Allen
Posted 4/27/2016 11:21 AM (GMT 0)
In my research comparing the brachytherapy methods of LDR and HDR, I understood that with each additional treatments could be performed in the event of localized recurrence. With intermediate to high risk diagnosis, everyone I spoke with suggested adjuvant EBRT.

I chose HDR because it appeared incrementally better than LDR in its ability to be more conformal to the cancer in both area and radiation intensity. This reduces the LDR "hot and cold spots" that can result in either worse side effects and/or inferior cancer control. Additionally, the inherent body changes and movement over time means the LDR radiation will not be applied in exactly the way the plan called for. Since HDR is applied quickly (15 minutes versus several months) there is no body changes or radiation migration that are inherent with seeds.

To Allen's most important point: regardless of the treatment protocol be it surgery, radiotherapy, drug based, or AS; the most critical element is choosing the very best practitioner. A great LDR seed implant will be better than a lousy HDR procedure; a great open RP will be better than an average DaVinci, and so on.

The use of brachytherapy as a salvage method also should help to counter the red herring that many surgeons posit when they contend that if radiotherapy fails then salvage surgery isn't available. Actually radiotherapy rarely fails the local area, but if it does there are generally ways that radiotherapy can be applied for salvage treatment.
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