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Both kinds of brachytherapy are good for salvage after failure of first-line radiation

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Posted 8/29/2017 5:07 AM (GMT 0)
This study from MSK compared salvage low dose rate brachytherapy (seeds) to high dose rate brachytherapy (temporary implants) as treatments after failure of primary radiotherapy. They were equally effective (about 60% by 3 years) and had equally low rates of toxicity. I'm sure their effectiveness will go up considerably with better patient selection using the new generation of PET scans:

/pcnrv.blogspot.com/2017/08/after-failure-of-first-line-radiation.html

Also, NIH will soon start recruitment for a salvage SBRT clinical trial. The clinical trial in San Diego (Don Fuller) has reported a 2-year recurrence-free survival of 82%, so those of you who can't travel to San Diego for that might sign up. They are also screening with the DCFPyL PET scan, which is the best of the new generation. Because it's NIH, it is free and they cover travel and accommodations to D.C. Here's the contact info:

/clinicaltrials.gov/ct2/show/NCT03253744
Posted 8/29/2017 12:36 PM (GMT 0)
TA: Thanks for the great info. Good to have this in the bank in case the beast comes back.
Posted 8/29/2017 2:14 PM (GMT 0)
Allen, thanks. This is consistent with a number of posts you have made over the years in response to fears of "no back up plan after radiation".

Jim
Posted 8/29/2017 3:56 PM (GMT 0)
Just this month, a man in my support group who had a radiation failure was told by his experienced urologist at USC that he could not have any more radiation to his prostate, and salvage surgery is his only recourse. I'm still trying to convince him otherwise. Surgeons often speak so authoritatively, it's hard for a non-professional like me to convince a patient that the surgeon is outside of his depth when he opines on radiation.
Posted 8/29/2017 4:28 PM (GMT 0)
Thanks TA....I fear the worst with my radiation treatment...being 70% cancerous.....just not convinced my treatment worked ...only time will tell, but your post here gives me hope for future treatments .....David
Posted 8/29/2017 5:06 PM (GMT 0)
The reality is that Radiation treatment requires far fewer salvages than does surgery. Simply, the radiation is just as effective at alleviating cancer as surgery, and the radiation treatment field is significantly larger than the area the surgeon can cut out. When initial radiation therapy isn't curative it almost always is because there was cancer already outside the radiation field.

Drifter, you have a very high probability of success, but it will take a while for you to be able to determine that. As you know, I also used radiation for my initial treatment and was a higher risk profile than you. I am now nearly seven years after treatment and remain with an undetectable PSA. I won't call it cured yet, but it sure is great so far. Stay patient and allow that radiation to work as it takes two to three years for some of the damaged cells to finally die off.
Posted 8/29/2017 5:36 PM (GMT 0)
You should never ask the advise of a Urologist concerning radiation treatment..Most are very ignorant about what is and is not possible...

I suspect patient selection is very important when considering salvage brachy to people who failed their primary radiation treatment. If that primary treatment was done correctly, there should be few failures unless the horse had left the barn before primary treatment began. If that is the case, then the salvage brachy is not going to work either..
Those considering primary radiation treatment should choose their RO carefully so as to avoid any "salvage" attempts later on....Do it right the first time please...
Posted 8/29/2017 6:45 PM (GMT 0)
TA, thanks this is great information and precisely the type of new research on salvage treatment modalities what I'm counting on in the event I ever have to face recurrence and secondary treatment. I'm assuming the primary RT treatment modality didn't matter, or did they target specific primary RT modalities (such as beam only vs BT)?
Posted 8/29/2017 7:05 PM (GMT 0)
HitchHiker-
I haven't read the full text where that question would be answered. I know that at least 41 of the 62 patients, and possibly all of them, who got salvage HDRBT had only external beam previously.

As JNF wrote, there aren't as many local recurrences when higher dose types of radiation are used, and conventional IMRT is the most popular primary therapy, so I'd expect that the vast majority of patients in studies like this had IMRT previously.

But even with brachy boost therapy there can be the odd hypoxic tumor that wasn't completely killed, and there can be the rare cold spots. I think a PSMA PET scan ought to be used to rule out distant mets.
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