Marieke van Son

133 TOXICITY AFTER ULTRAFOCAL SALVAGE HDR-BRACHYTHERAPY was mainly characterized by transient mild symptoms of haematuria, urinary frequency and urinary tract pain, which are common acute symptoms after brachytherapy. In the late phase, moderate urinary frequency became more frequent, as well as moderate urinary incontinence and urinary retention. Erectile function generally decreased over time, with increasing frequencies across the range of mild to severe symptoms. Although the CTCAE is commonly used to describe treatment-related toxicities, the se- verity of symptoms and their grading varies between subdomains. The general guideline states that grade 2 toxicity refers to moderate symptoms indicating minimal, local or non- invasive intervention, whereas grade 3 toxicity involves disabling symptoms limiting self- care activities of daily living or (prolongation of) hospitalization(12). Within the subdomain urinary retention, grade 2 toxicity includes placement of a urinary or suprapubic catheter or intermittent catheterization, besides use of medication. In our group, 7 patients with grade 2 urinary retention required a (temporary) urinary catheter (2/7), a (temporary) suprapubic catheter (4/7) or needed self-catheterization (1/7). Since these interven- tions have substantial impact on daily life activities, we urge to report them separately. In recent years, an increasing amount of literature on focal salvage HDR-BT has become available. Table 4 summarizes four studies using different focal HDR-BT reg- imens and targeting strategies, who all reported GU and GI toxicities using the CTCAE 4.0. Across these studies, 2-10% grade 3 GU and 0% grade 3 GI toxicity was reported. Acute and late grade 2 GU toxicity was observed in 54-93% and 42-47% of patients. Two studies specified grade 2 retention: Murgic et al. described that no patient required a urinary catheter, while Chitmanee et al. had patients requiring intermittent catheteriza- tion (n=9), urethral dilatation (n=1) and a suprapubic catheter (n=1). Acute and late grade 2 GI toxicity occurred in 0-8% and 0-13%. Grade 1 GU toxicity was observed in 0-36% (acute) and 20-26% (late), and grade 1 GI toxicity in 14-24% (acute) and 14-22% (late). In comparison, retrospective studies on other focal salvage modalities such as HIFU, cryotherapy and irreversible electroporation (IRE) have described similarly low com- plication rates(17-19). However, future results from prospective multi-center trials will provide more insight in the role of focal salvage IRE (FIRE trial, ACTRN12617000806369) and focal salvage HIFU/cryotherapy (FORECAST trial, NCT01883128). 7