S174
Brachytherapy - Urology
ESTRO 2026
Digital Poster 4351
High-dose-rate brachytherapy as salvage treatment for biochemical recurrence after external beam radiotherapy in prostate cancer Maria Calderó Torra 1 , Angie Y Ramos de los Ríos 1 , Rocío DP Pérez Orozco 1 , Fernando M Jaramillo Ocharan 1 , Cristina Pozuelo Aso 1 , Luís Sopeña Sanz 1 , Carmen Velilla Millán 1 , Alejandro García Romero 2 , Francisco X Elizalde Benito 3 1 Radiation Oncology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. 2 Radiophysics, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. 3 Urology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
Purpose/Objective: Biochemical recurrence after external beam
radiotherapy (EBRT) for localized prostate cancer remains a therapeutic challenge. Among the available salvage options, high-dose-rate (HDR) brachytherapy offers the potential for effective local control with acceptable toxicity. This study aimed to evaluate clinical outcomes, toxicity, and recurrence patterns in patients treated with HDR brachytherapy as salvage therapy after previous EBRT. Material/Methods: We performed a retrospective analysis of patients with prostate cancer previously treated with EBRT who developed biochemical recurrence and underwent HDR brachytherapy as salvage treatment between 2017 and 2025 at our institution.Collected data included patient demographics, initial diagnosis, prior treatment and dose, type and confirmation of recurrence, HDR dose schedule, use and duration of androgen deprivation therapy (ADT), acute toxicity (CTCAE), and follow-up outcomes.The HDR brachytherapy procedure was performed on an outpatient basis; patients were admitted and discharged on the same day, and were discharged without a urinary catheter in place. Results: A total of 26 patients were treated with salvage HDR brachytherapy, 17 of whom (65.4%) also received ADT for either 6 months or 2 years.Patients were treated with total doses of 25 or 24 Gy, delivered in two treatment fractions. The mean age at salvage was 73.1 years (60.3–80.4). Acute grade 1 urinary toxicity occurred in 7.7% of patients. No other toxicities were observed.New recurrence was observed in 3 cases, with two patients developing recurrence in iliac and retroperitoneal lymph nodes, and one patient in the sacral bone. Progression-free survival was 16.8 months. The median follow-up of the study was 34.7 months. Conclusion: Salvage HDR brachytherapy after EBRT appears to be a
Results: Planning aims followed the GEC-ESTRO
recommendations [3]. Adequate CTV coverage was achieved in all cases (CTV D90 mean 107.3%, range 101–112%) without exceeding tolerance limits for organs at risk (urethra D10 = 106%, range 101%-109%, rectal wall Dmax = 57.3%, range 39%- 69%. The overall treatment time averaged less than four hours. No treatments were cancelled due to technical issues such as difficulties achieving coverage or pubic bone interference. Conclusion: The presented workflow provides a one-room solution using relatively affordable equipment and a total treatment time that enables multiple patients to be treated daily. The combination of an upward-tilted TRUS probe, the bent stylet for needle adjustment, and C-arm verification addresses some of the key technical challenges in ultrasound-guided HDR brachytherapy, enabling fast and reliable treatments. Keywords: Prostate, HDR, Ultrasound References: 1. Pettersson, A., et al., Comparative Effectiveness of Different Radical Radiotherapy Treatment Regimens for Prostate Cancer: A Population-Based Cohort Study. JNCI Cancer Spectr, 2020. 4(2): p. pkaa006.2. Miszczyk, M., et al., Brachytherapy boost improves survival and decreases risk of developing distant metastases compared to external beam radiotherapy alone in intermediate and high risk group prostate cancer patients. Radiother Oncol, 2023. 183: p. 109632.3. Henry, A., et al., GEC-ESTRO ACROP prostate brachytherapy guidelines. Radiother Oncol, 2022. 167: p. 244–251.
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