Image-Guided Robotic Radiosurgery as Salvage Therapy for Locally Recurrent Prostate Cancer after External Beam Irradiation: Retrospective Feasibility Study on Six Cases

Vavassori, Andrea; Jereczek‐Fossa, Barbara Alicja; Beltramo, G.; Cicco, Luigi De; Fariselli, Laura; Bianchi, Livia; Possanzini, M.; Bergantin, A.; Decobelli, O.; Orecchia, Roberto

doi:10.1177/030089161009600112

Cited by 46 publications

(48 citation statements)

References 38 publications

(36 reference statements)

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“…Vavassori et al published the first results on prostate re-irradiation using this system. In this preliminary retrospective case series including 6 patients treated with a total dose of 30 Gy in 5 fractions on the whole prostate gland, 2 patients remained bNED after 11.2 months of median follow-up [18]. Since then, Fuller et al published a retrospective study including 29 patients treated with a total dose of 34 Gy in 5 fractions within a median follow-up of 24 months.…”

Section: Discussionmentioning

confidence: 99%

Salvage prostate re-irradiation using high-dose-rate brachytherapy or focal stereotactic body radiotherapy for local recurrence after definitive radiation therapy

et al. 2017

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BackgroundOptimal management of locally recurrent prostate cancer after definitive radiation therapy is still challenging. With the development of highly accurate radiotherapy devices, prostate salvage re-irradiation might generate lower toxicity rates than classical salvage therapies. We retrospectively evaluated the toxicity and the feasibility of a prostate re-irradiation after definitive radiation therapy failure. Two modalities were investigated: high-dose-rate brachytherapy (HDRB) on whole prostate gland and focal stereotactic radiotherapy (SBRT) using CyberKnife® linac.MethodsBetween 2011 and 2015, 28 patients with imaged and/or biopsy-proven intra-prostatic recurrence of cancer after definitive radiation therapy underwent a salvage re-irradiation using HDRB (n = 10) or focal SBRT (n = 18). The schedule of re-irradiation was 35 Gy in 5 fractions.Biological response (defined as post-salvage radiation PSA variation) and biochemical no-evidence of disease (bNED) were evaluated in the whole cohort. For patients who had a positive biological response after salvage radiation, biochemical recurrence (BCR) and survival after salvage radiotherapy were evaluated. Post-salvage toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.03 and were compared to baseline status.ResultsWithin a median follow-up of 22.5 months (IQR = 8–42), 9 (90%) patients experienced a positive biological response after salvage HDRB and 5 (50%) remained bNED at the end of the follow-up. Among patients who initially responded to salvage HDRB, the BCR rate was 44.4% after a median interval of 19.5 months (IQR = 11.5–26). Only one patient experienced a transient grade 3 urinary complication.In the SBRT group, the median follow-up was 14.5 months (IQR = 7–23) and 10 (55.6%) out of the 18 patients remained bNED. Among the 15 patients who initially responded to salvage SBRT, 5 (33.3%) experienced a BCR. One patient experienced a transient grade 4 urinary complication.At the end of the follow-up, all evaluated patients had a urinary status grade variation ≤ +1 grade. No grade 3–4 digestive toxicity was observed.ConclusionsSalvage prostate re-irradiation for locally recurrent cancer is feasible and generate low toxicities rates when using with HDRB or focal SBRT. However, further investigations are necessary to confirm these findings and to determine predictive features for patients who might benefit from such an approach.

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Section: Discussionmentioning

confidence: 99%

Salvage prostate re-irradiation using high-dose-rate brachytherapy or focal stereotactic body radiotherapy for local recurrence after definitive radiation therapy

et al. 2017

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“…8,9 Ablative hypofractionation regimens are commonly chosen for high-precision RT, which may increase the chance of killing prostate cancer cells, owing to their low alpha/beta ratio. Recently, several reports on stereotactic prostate reirradiation have been published: Vavassori et al 10 reported the preliminary results on six patients treated with Cyberknife SBRT (30 Gy in five fractions over five consecutive days). This study was later updated by Jereczek-Fossa et al: 11 complete response was obtained in six out of nine patients (without any systemic therapy) with a low toxicity profile (no rectal toxicity and few urinary events).…”

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confidence: 99%

Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer

Zerini¹,

Jereczek‐Fossa²,

Fodor³

et al. 2015

BJR

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“…To the best of our knowledge, there is only one study regarding reirradiation using EBRT. Vavassori et al (11) reported cases of reirradiation using CyberKnife ® for locally recurrent prostate cancer after primary EBRT (median dose of 80 Gy). A total dose of 30 Gy in 5 fractions was administered, and no patients experienced severe urinary or rectal toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Salvage re-irradiation for recurrent prostate cancer after primary EBRT has been limited due to toxicity to adjacent organs, particularly the rectum and bladder (10). Although, certain recent studies have reported the effectiveness and safety of re-irradiation with brachytherapy for locally relapsed prostate cancer, reports of re-irradiation using EBRT are scarce (11,12). Thus, in the present study, two cases of locally relapsed prostate cancer following EBRT treated with re-irradiation using helical tomotherapy are discussed.…”

Section: Introductionmentioning

confidence: 92%

Salvage helical tomotherapy for prostate cancer recurrence following definitive external beam radiotherapy: A case report

2015

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Abstract. Salvage prostatectomy for recurrent prostate cancer after external beam radiotherapy (EBRT) has resulted in positive outcomes; however, it is technically challenging and is associated with a number of risks. When a patient exhibits recurrent prostate cancer following definitive EBRT and presents with comorbidities meaning that they cannot receive a prostatectomy, it is difficult to treat due to the numerous limitations of current salvage therapies. In the present study, two cases of salvage reirradiation using helical tomotherapy for locally recurrent prostate cancer following definitive EBRT are presented. The two patients received EBRT without severe complications. Local recurrence was confirmed by serum levels of prostate-specific antigen, repeat prostate biopsy, prostate magnetic resonance imaging and a bone scan. Salvage reirradiation using helical tomotherapy was performed and resulted in promising outcomes without any complications. In conclusion, helical tomotherapy can be a safe and effective salvage treatment modality for locally recurrent prostate cancer following definitive EBRT.

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Image-Guided Robotic Radiosurgery as Salvage Therapy for Locally Recurrent Prostate Cancer after External Beam Irradiation: Retrospective Feasibility Study on Six Cases

Abstract: Salvage radiosurgery with CyberKnife after irradiation is feasible with low urinary and rectal morbidity. A longer follow-up and a larger number of patients are necessary to evaluate its effectiveness and optimal patient selection criteria.

Cited by 46 publications

References 38 publications

Salvage prostate re-irradiation using high-dose-rate brachytherapy or focal stereotactic body radiotherapy for local recurrence after definitive radiation therapy

Salvage prostate re-irradiation using high-dose-rate brachytherapy or focal stereotactic body radiotherapy for local recurrence after definitive radiation therapy

Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer

Salvage helical tomotherapy for prostate cancer recurrence following definitive external beam radiotherapy: A case report

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