Nonsurgical Salvage Local Therapies for Radiorecurrent Prostate Cancer: A Systematic Review and Meta-analysis

Ingrosso, Gianluca; Becherini, Carlotta; Lancia, Andrea; Caini, Saverio; Ost, Piet; Francolini, Giulio; Høyer, Morten; Bottero, Marta Carla; Bossi, Alberto; Zilli, Thomas; Scartoni, D.; Livi, Lorenzo; Santoni, Riccardo; Giacomelli, Irene; Detti, Beatrice

doi:10.1016/j.euo.2018.12.011

Cited by 50 publications

(52 citation statements)

References 73 publications

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“…A recent systematic review by Ingrosso et al . [17] shows promising outcomes of these non‐surgical treatments, although conclusions with a high level of evidence could not be made. One should be aware that many studies of SCS are from the same centres of excellence, possibly resulting in publication bias of positive studies by reporting overlapping results [18].…”

Section: Discussionmentioning

confidence: 99%

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

et al. 2020

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Objectives To evaluate the oncological and functional outcomes of salvage cryosurgery (SCS) for radiorecurrent prostate cancer (rrPCa). Patients and Methods A total of 169 consecutive patients with biopsy confirmed rrPCa were retrospectively analysed. All patients underwent SCS in a single referral centre between 2006 and 2018. The primary outcome was biochemical recurrence‐free survival (BRFS) according to the Phoenix definition (prostate‐specific antigen [PSA] nadir +2 ng/mL). The secondary outcomes were overall survival, BRFS defined as a PSA level of >0.5 ng/mL, metastasis‐free survival, androgen‐deprivation therapy (ADT)‐free survival, and functional outcomes. Complications were classified according to the Clavien–Dindo system. PSA was measured every 3–6 months postoperatively. Functional outcomes were scored as reported by patients at outpatient visits. Kaplan–Meier survival analysis and uni‐ and multivariable Cox regression were performed. Results The median (interquartile range) follow‐up was 36 (18–66) months. The BRFS after 5 and 8 years was 52% (95% confidence interval [CI] 43–62%) and 45% (95% CI 35–57%), respectively. At multivariable analysis PSA level at initial diagnosis, initial treatment, interval between primary treatment and SCS, age at SCS, and post‐SCS PSA nadir were significant factors for BRFS. The 5‐year ADT‐free survival was 70% (95% CI 62–79%). Clavien–Dindo Grade ≥III complications occurred in 1.2% (two/169) of patients. In all, 19% (29/156) of patients had new‐onset urinary incontinence defined as >1 pad/24 h and 92% (57/62) of patients had new‐onset erectile dysfunction. Persistent urinary fistula occurred in 6.5% (11/169) of patients. Conclusions The present study shows acceptable oncological outcomes of SCS considering the salvage character of the treatment. The occurrence of serious complications such as urinary incontinence and fistula should not be underestimated.

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Section: Discussionmentioning

confidence: 99%

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

et al. 2020

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“…In addition, most patients did not undergo fluciclovine/prostate specific membrane antigen (PSMA) PET scans at the time of first failure due to lack of availability in the United States. Additionally brachytherapy and prostatectomy, which is a viable option for patients experiencing local failure, was not offered to our patient cohort (51). This typically reflects patient preference to minimally invasive procedures.…”

Section: Discussionmentioning

confidence: 99%

Management of Isolated Local Failures Following Stereotactic Body Radiation Therapy for Low to Intermediate Risk Prostate Cancer

et al. 2020

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Background: Stereotactic body radiation therapy (SBRT) is a safe and effective treatment option for patients with low to intermediate risk prostate cancer (1). SBRT results in very low PSA nadirs secondary to the delivery of high biologically effective doses. Studies reporting on the diagnosis, confirmation, and management of salvageable isolated local failures (ILF) are limited. This study aims to determine the incidence and management approach of ILF after SBRT in a large single institution cohort. Method: All patients with low or intermediate risk localized prostate cancer treated with SBRT at Georgetown University Hospital were eligible for this study. Treatment was delivered using robotic SBRT with doses of 35-36.25 Gy in five fractions. ILF were diagnosed using multiparametric MRI and/or biopsy prompted by rising PSA levels after achieving long-term nadir. Patient's characteristics were extracted from a prospective institutional quality of life trial (IRB 2009-510). Type of salvage therapy and post-salvage PSA were determined on subsequent follow-up and chart review. Results: Between December 2008 to August 2018, 998 men with low to intermediate risk prostate cancer were eligible for inclusion in this analysis. Twenty-four patients (low risk, n = 5; intermediate risk, n = 19) were found to have ILF within the prostate on either MRI (n = 19) and/or biopsy (n = 20). Median pre-treatment PSA was 7.55 ng/ml. Median time to diagnosis of ILF was 72 months (24-110 months) with median PSA at the time of ILF of 2.8 ng/ml (0.7-33 ng/ml). Median PSA doubling time was 17 months (5-47 months). Thirteen patients with biopsy proven ILF proceeded with salvage therapy (cryotherapy n = 12, HIFU n = 1). Of 12 patients who underwent cryotherapy, 7 had a post-treatment PSA of <0.1 ng/ml. One patient experienced a urethral-cutaneous fistula (grade 3 toxicity). Aghdam et al. Isolated Local Failures Following SBRT Conclusion: The incidence of isolated local recurrence is rare in our cohort. Diagnosis and management of isolated local failures post-SBRT continues to evolve. Our report highlights the importance of early utilization of MRI and confirmatory biopsy at relatively low PSA levels and long PSA doubling time (1). Additionally, undetectable PSA levels after salvage therapy supports the role of early treatment in ILF (1). Further research is needed to determine appropriate patient selection and salvage modality in this population.

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“…The pelvis is a major site for ReRT-BT in the Japanese cohort. It is natural because gynecological and prostate lesions could be good candidates not only for fresh BT but also for ReRT-BT with accumulated evidence (5)(6)(7)(8)(9). However, the fact that low-volume head neck tumor could be a good candidate to curative ReRT-BT is well documented and has a long history (12)(13)(14)23); however, fewer cases are salvaged by ReRT-BT in Japan.…”

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confidence: 99%

A national surveillance study of the current status of reirradiation using brachytherapy in Japan

et al. 2021

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This study aimed to explore the current status and pattern of practice for reirradiation using brachytherapy (ReRT-BT) through a survey in Japan. MATERIALS AND METHODS:We distributed an e-mail-based questionnaire to 153 institutions equipped with high-dose-rate brachytherapy facilities. RESULTS: We received responses from 76 institutions (49.7%). Forty-three of these institutions performed ReRT-BT and 42 institutions (55%) performed ReRT-BT during 2009e2018. However, 29 of the 42 institutions (69%) reported difficulty in obtaining ReRT-BT case information from their respective databases. Almost all the institutions encountered insufficient database system to extract details about the ReRT-BT cases. Responses from 33 institutions included the number of ReRT-BT cases; this increased from 90 in the period 2009e2013 (institution median 5 0.5; 0e 16) to 172 in the period 2014e2018 (institution median 5 2; 0e26). Nine institutions had to perform ReRT-BT for more than one case per year. The major location for cancer treatment was the pelvis (94%), followed by the head and neck (5%) and others (1%). In six site-specific scenarios, barring uterine corpus cancer recurrence, more than 90% of radiation oncologists agreed to perform ReRT-BT, whereas other areas (head and neck, prostate, and rectal cancer) gained 16e37% agreement. CONCLUSIONS: This decade saw an increase in the number of ReRT-BT cases in Japan and radiation oncologists' interest in ReRT-BT as a viable therapeutic option. However, scarce availability, immature education system, and insufficient database system are barriers to further consensus building.

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Nonsurgical Salvage Local Therapies for Radiorecurrent Prostate Cancer: A Systematic Review and Meta-analysis

Cited by 50 publications

References 73 publications

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

Functional and oncological outcomes of salvage cryosurgery for radiorecurrent prostate cancer

Management of Isolated Local Failures Following Stereotactic Body Radiation Therapy for Low to Intermediate Risk Prostate Cancer

A national surveillance study of the current status of reirradiation using brachytherapy in Japan

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