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To describe long-term outcomes and toxicity after salvage brachytherapy (BT) for local failure after initial radiotherapy for prostate cancer.Between 1994 and 2008, 37 men with local failure after initial prostate radiotherapy (32 external-beam radiation therapy [EBRT] and 5 BT) underwent salvage BT with (103)Pd or (125)I. Estimates of freedom from biochemical failure (FFbF, Phoenix definition) and cause-specific survival (CSS) were calculated using the Kaplan-Meier method. Toxicities were graded using CTCv3.0.Median follow-up was 86 months (range, 2-156). The median dose to 90% of the prostate volume was 122 Gy (range, 67-166). The 10-year FFbF and CSS were 54% and 96%, respectively. On univariate analysis, prostate-specific antigen (PSA)10 ng/mL at initial diagnosis was significantly associated with FFbF (p = 0.01), and there were trends for both age70 years (p = 0.08) and PSA6 ng/mL (p = 0.08) at the time of salvage BT. On multivariate analysis, only presalvage PSA6 ng/mL (p = 0.046) was significantly associated with improved FFbF. There were three Grade 3 toxicities and one Grade 4 toxicity. Pelvic lymph node dissection before salvage BT was the only variable significantly associated with Gradeor = 2 toxicity (p = 0.03).With a median follow-up of 86 months, salvage prostate BT was associated with a 10-year FFbF of 54% and CSS of 96%. Improved FFbF was associated with a presalvage PSA6 ng/mL. Toxicity was worse in patients who had undergone pelvic lymph node dissection before salvage BT. Careful patient selection for salvage BT may result in improved outcomes and reduced toxicity.

To evaluate the influence of patient- and treatment-related factors on freedom from biochemical failure (FFbF) in patients with intermediate-risk prostate cancer.From a prospectively collected database of 2250 men treated at Mount Sinai Hospital from 1990 to 2004 with low-dose-rate brachytherapy for prostate cancer, 558 men with either one or more intermediate-risk features (prostate-specific antigen [PSA] level 10-20 ng/mL, Gleason score 7, or Stage T2b) were identified who had a minimum follow-up of 24 months and postimplant CT-based dosimetric analysis. Biologically effective dose (BED) values were calculated to compare doses from different isotopes and treatment regimens. Patients were treated with brachytherapy with or without hormone therapy and/or external-beam radiotherapy. Patient- and treatment-related factors were analyzed with respect to FFbF. The median follow-up was 60 months (range, 24-167 months). Biochemical failure was defined according to the Phoenix definition. Univariate analyses were used to determine whether any variable was predictive of FFbF. A two-sided p value of0.05 was considered significant.Overall, the actuarial FFbF at 10 years was 86%. Dose (BED150 Gy(2) vs.or=150 Gy(2)) was the only significant predictor of FFbF (p0.001). None of the other variables (PSA, external-beam radiotherapy, Gleason score, treatment type, hormones, stage, and number of risk factors) was found to be a statistically significant predictor of 10-year FFbF.Radiation dose is an important predictor of FFbF in intermediate-risk prostate cancer. Treatment should continue to be individualized according to presenting disease characteristics until results from Radiation Therapy Oncology Group trial 0232 become available.

Purpose Combined brachytherapy and external beam radiation therapy (EBRT) of the prostate and seminal vesicles (SVs) is evolving as a successful treatment option for high-risk prostate cancer. Dose–volume histogram (DVH) analysis of the SV was performed in patients with biopsy-positive SV who received implantation of the SV and prostate. Methods and materials Fifteen consecutive patients with high-risk features (prostate-specific antigen [PSA] ≥ 10 ng/mL, Gleason score ≥7, or clinical stage ≥T2b) and a positive SV biopsy were treated with a 103Pd implant of the prostate and SV followed by 45 Gy of EBRT. DVHs were generated for the prostate and total SV volume (SVT). In addition, the SV was divided into 3-mm-thick volumes identified as SV1, SV2, SV3, SV4, SV5, and SV6 starting from the junction of the prostate and SV and extending distally. Delivered dose was defined as the D90 (dose delivered to 90% of the organ on DVH). Results The median number of seeds implanted into the prostate and the SVT was 59 (41–94) and 9 (4–21), respectively. The median D90 values for the prostate, SVT, SV1, SV2, SV3, SV4, SV5, and SV6 were 103.2 (87.4–137.1), 46.2 (4.0–69.4), 76.0 (31.2–147), 63.4 (25.1–145.9), 49.7 (15.3–118), 27.4 (9.3–135.1), 14.2 (2.3–100.3), and 3.9 (0–61.5) Gy, respectively. Conclusions Implantation of the SV using a real-time intraoperative approach is technically feasible and results in higher doses to the SV than has been reported with implantation of the prostate alone. Although dose distribution in the SV can be variable and unpredictable, these doses, in combination with 45 Gy of EBRT, may be adequate to control disease spread in these organs.

Purpose/Objective(s): Locally advanced non-small cell lung carcinoma remains a therapeutic challenge for clinicians. Currently the standard of care is multimodality therapy, but sequencing of multimodality therapy is unclear. Population based studies suggest that neoadjuvant radiation (N-RT) offers an overall and cause-specific survival benefit over adjuvant radiation (A-RT) in the treatment of Stage III NSCLC. The goal of this study was to identify the factors which affect the survival benefit of neoadjuvant radiation in Stage III NSCLC.