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Br J Radiol. 2019 Feb;92(1094):20180494. doi: 10.1259/bjr.20180494. Epub 2018 Nov 9.

Reirradiation for isolated local recurrence of prostate cancer: Mono-institutional series of 64 patients treated with salvage stereotactic body radiotherapy (SBRT).

Author information

1
1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.
2
2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy.
3
3 Unit of Medical Physics, European Institute of Oncology IRCCS , Milan , Italy.
4
4 Radiation Research Unit, European Institute of Oncology IRCCS , Milano , Italy.
5
5 Division of Radiology, European Institute of Oncology IRCCS , Milan , Italy.
6
6 Division of Urology, European Institute of Oncology IRCCS , Milan , Italy.
7
7 Scientific Directorate, European Institute of Oncology IRCCS , Milan , Italy.

Abstract

OBJECTIVE::

To evaluate high-precision external beam reirradiation (re-EBRT) for local relapse of prostate cancer (PCa) after radiotherapy.

METHODS::

This retrospective study included patients with biochemical failure and evidence of isolated local recurrence of PCa after radical/salvage EBRT or brachytherapy that received salvage stereotactic body radiation therapy (SBRT, re-EBRT). Biopsy was not mandatory if all diagnostic elements were univocal (prostate specific antigen evolution, choline-positron emission tomography or magnetic resonance imaging). Salvage SBRT (re-EBRT) was delivered with image-guided radiation therapy (RapidArc®, VERO® and CyberKnife®).

RESULTS::

Data of 64 patients were included, median age at salvage SBRT was 73.2 years, median pre-salvage SBRT prostate specific antigen was 3.89  ng ml-1 . Median total dose was 30  Gy in five fractions, biologically effective dose (BED) of 150  Gy. One acute G3 genitourinary event and one late G3 genitourinary event were observed. No G ≥ 3 bowel toxicity was registered. At the median follow-up of 26.1 months, tumor progression was observed in 41 patients (64%). 18 patients (28%) experienced local relapse. 2-year local control, biochemical and clinical relapse free survival rates were 75, 40 and 53%, respectively. With BED ≥130  Gy 1-year biochemical and clinical progression-free survival rate were 85 and 90%, respectively.

CONCLUSIONS::

Salvage SBRT (re-EBRT) for isolated local PCa recurrence is a safe, feasible and noninvasive salvage treatment. Further investigation is warranted to define the optimal patient selection, dose and volume parameters.

ADVANCES IN KNOWLEDGE::

Salvage SBRT reirradiation for the locally recurrent PCa offer a satisfactory tumor control and excellent toxicity profile, if BED ≥130 Gy is administered.

PMID:
30379566
PMCID:
PMC6404844
[Available on 2020-02-01]
DOI:
10.1259/bjr.20180494
[Indexed for MEDLINE]
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