Macroscopic locoregional relapse from prostate cancer: which role for salvage radiotherapy?

Bruni, Alessio; Ingrosso, Gianluca; Trippa, Fabio; Staso, Mario Di; Lanfranchi, B.; Rubino, Laura; Parente, S.; Frassinelli, L.; Maranzano, Ernesto; Santoni, Riccardo; Sighinolfi, Maria Chiara; Lohr, Frank; Mazzeo, E.

doi:10.1007/s12094-019-02084-0

Cited by 14 publications

(22 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our analysis, we did not find any statistically significant difference between radiotherapy with or without boost, with regard to biochemical progression-free survival; nor did they in the retrospective study by A. Bruni et al (11) in which no statistical advantage was found in the group receiving the increased dose (>70 Gy) with regard to OS or to mPFS. In another study by Zilli et al (12), there is no significant difference in 3-year biochemical-progression-free survival between standard prostate bed therapy targeting a microscopic disease and boosted treatment if a nodule is identified by MRI (74 Gy: 68.4 months ± 4.6/64 Gy: 49.7 months ± 10.0).…”

Section: Discussioncontrasting

confidence: 73%

Salvage Radiotherapy for Macroscopic Local Recurrence Following Radical Prostatectomy

et al. 2021

View full text Add to dashboard Cite

IntroductionSalvage radiotherapy is the only curative treatment for biochemical progression after radical prostatectomy. Macroscopic recurrence may be found in the prostatic bed. The purpose of our study is to evaluate the effectiveness of salvage radiotherapy of the prostate bed with a boost to the area of the macroscopic recurrence.Material and MethodsFrom January 2005 to January 2020, 89 patients with macroscopic recurrence in the prostatectomy bed were treated with salvage radiotherapy +/- hormone therapy. The average PSA level prior to radiotherapy was 1.1 ng/mL (SD: 1.6). At the time of biochemical progression, 96% of the patients had a MRI that revealed the macroscopic recurrence, and 58% had an additional choline PET scan. 67.4% of the patients got a boost to the macroscopic nodule, while 32.5% of the patients only underwent radiotherapy of the prostate bed without a boost. The median total dose of radiotherapy was 70 Gy (Min.: 60 – Max.: 74). The most commonly-used regimen was radiotherapy of the prostatectomy bed with a concomitant boost. 48% of the patients were concomitantly treated with hormone therapy.ResultsAfter a median follow-up of 53.7 months, 77 patients were alive and 12 had died, of which 4 following metastatic progression. The 5-year and 8-year survival rates (CI95%) are, respectively, 90.2% (78.9-95.6%) and 69.8% (46.4-84.4%). The 5-year biochemical progression-free survival rate (CI95%) is 50.8% (36.7-63.3). Metastatic recurrence occurred in 11.2% of the patients. We did not find any statistically significant impact from the various known prognostic factors for biochemical progression-free survival. No toxicity with a grade of > or = to 3 was found.ConclusionsOur series is one of the largest published to date. Salvage radiotherapy has its place in the management of patients with biochemical progression with local recurrence in the prostate bed, with an acceptable toxicity profile. The interest of the boost is to be evaluated in prospective trials.

show abstract

Section: Discussioncontrasting

confidence: 73%

Salvage Radiotherapy for Macroscopic Local Recurrence Following Radical Prostatectomy

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Bruni et al also conducted a multicenter retrospective analysis to evaluate the role of SRT in patients with locoregional CR ( n = 105). 6 At the median follow-up of 52 months, the 5-year estimates for those patients were 70%, 86%, and 86% for BCFFS, DMFS, and OS, respectively. 6 Above 2 studies used different biochemical definitions that the former used 0.2 ng/ml plus nadir and the latter used 0.5 ng/ml plus nadir, whereas we defined it as the serum PSA > 2.0 ng/ml plus nadir or initiation of salvage ADT after SRT.…”

Section: Discussionmentioning

confidence: 88%

“… 6 At the median follow-up of 52 months, the 5-year estimates for those patients were 70%, 86%, and 86% for BCFFS, DMFS, and OS, respectively. 6 Above 2 studies used different biochemical definitions that the former used 0.2 ng/ml plus nadir and the latter used 0.5 ng/ml plus nadir, whereas we defined it as the serum PSA > 2.0 ng/ml plus nadir or initiation of salvage ADT after SRT. There is no consensus on the definition of BCF after SRT and it remains controversial.…”

Section: Discussionmentioning

confidence: 88%

See 1 more Smart Citation

Clinical Outcome of Salvage Radiotherapy for Locoregional Clinical Recurrence After Radical Prostatectomy

Lee

Cho

Kim

et al. 2021

Technol Cancer Res Treat

View full text Add to dashboard Cite

Objectives: To assess the clinical outcomes of prostate cancer patients treated with salvage radiotherapy (SRT) for locoregional clinical recurrence (CR) after radical prostatectomy (RP). Methods: Records of 60 patients with macroscopic locoregional recurrence after prostatectomy and referrals for SRT were retrospectively investigated in the multi-institutional database. The median radiation dose was 70.2 Gy. Biochemical failure was defined as the prostate-specific antigen (PSA) ≥ nadir + 2 or initiation of androgen deprivation therapy (ADT) for increased PSA. Results: Median recurrent tumor size was 1.1 cm and pre-radiotherapy PSA level was 0.4 ng/ml. At a median follow-up of 83.1-month after SRT, 7-year biochemical failure-free survival (BCFFS), locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and overall survival (OS) were 67.0%, 89.7%, 83.6%, and 91.2%, respectively. Higher Gleason's scores were associated with unfavorable BCFFS, DMFS, and OS. Pre-SRT PSA ≥0.5 ng/ml predicted worse BCFFS, LRFFS, and DMFS. In multivariate analyses, a Gleason's score of 8 to 10 was associated with decreased BCFFS (hazard ratio [HR] 3.12, 95% confidence interval [CI] 1.11-8.74, P = .031) and OS (HR 17.72, 95% CI 1.75-179.64, P = .015), and combined ADT decreased the risks of distant metastasis (HR 0.18, 95% CI 0.04-0.92, P = .039). Two patients (3.3%) experienced late grade 3 urinary toxicity. Conclusions: SRT for locoregional CR after RP achieved favorable outcomes with acceptable long-term toxicities. Higher Gleason's scores and pre-radiotherapy PSA level were unfavorable prognostic variables. Combined ADT may decrease the risks of metastases.

show abstract

“…Macroscopic prostate bed recurrence is considered an uncommon event (< 10% of cases) for almost half of experts, but treatment intensification approaches in this case were recommended by vast majority of them. Sequential or simultaneous integrated boost on recurrence site were mainly proposed, in line with previous retrospective Italian experiences [41], but also stereotactic RT may play arole for these patients for a minority of experts [42]. Concerning pelvic isolated recurrences, the preferred approach for majority of participants was stereotactic nodal RT, despite a significant percentage of them recommending WPRT (30.7%).…”

Section: Discussionmentioning

confidence: 81%

Postoperative radiotherapy after upfront radical prostatectomy: debated issues at a turning point—a survey exploring management trends on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology)

et al. 2021

View full text Add to dashboard Cite

Objectives Postoperative prostate cancer patients are a heterogeneous population, and many prognostic factors (e.g., local staging, PSA kinetics, margin status, histopathological features) may influence their clinical management. In this complex scenario, univocal recommendations are often lacking. For these reasons, the present survey was developed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) to collect the opinion of Italian radiation oncologists and delineate a representation of current clinical practice in our country. Methods A questionnaire was administered online to AIRO (Italian Association of Radiotherapy and Clinical Oncology) members registered in 2020 with a clinical interest in uro-oncological disease. Results Sixty-one per cent of AIRO members answered the proposed survey. Explored topics included career and expertise, indications to adjuvant RT, additional imaging in biochemical recurrence setting, use of salvage radiotherapy (SRT), management of clinically evident locoregional recurrence and future considerations. Conclusions Overall, good level of agreement was found between participants for most of the topics. Most debated issues regarded, as expected, implementation of new imaging methods in this setting. Notably, trend in favour of early SRT vs. immediate adjuvant RT was underlined, and preference for global evaluation rather than isolated risk factors for RT indications was noticed.

show abstract

Macroscopic locoregional relapse from prostate cancer: which role for salvage radiotherapy?

Cited by 14 publications

References 22 publications

Salvage Radiotherapy for Macroscopic Local Recurrence Following Radical Prostatectomy

Salvage Radiotherapy for Macroscopic Local Recurrence Following Radical Prostatectomy

Clinical Outcome of Salvage Radiotherapy for Locoregional Clinical Recurrence After Radical Prostatectomy

Postoperative radiotherapy after upfront radical prostatectomy: debated issues at a turning point—a survey exploring management trends on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology)

Contact Info

Product

Resources

About