Prostatectomy Bed Image-guided Dose-escalated Salvage Radiotherapy (SPIDER): An International Multicenter Retrospective Study

Benziane-Ouaritini, Nicolas; Zilli, Thomas; Giraud, Antoine; Ingrosso, Gianluca; Staso, Mario Di; Trippa, Fabio; Pommier, P.; Meyer, Edgar F.; Schick, Ulrike; Pasquier, David; Cosset, J.M.; Magné, Nicolas; Martin, Étienne; Gnep, Kémara; Renard-Penna, R.; Anger, Ewen; Achard, Vérane; Giraud, Nicolas; Aristei, Cynthia; Ferrari, Victoria; Pasquier, Corentin; Zaine, Hind; Osman, Osman; Detti, Beatrice; Perennec, Tanguy; Mihoci, Inga; Supiot, S.; Latorzeff, I.; Sargos, P.

doi:10.1016/j.euo.2023.02.013

Cited by 8 publications

(6 citation statements)

References 36 publications

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“…When a local relapse was visible on preradiation imaging (in 27% of patients), it was contoured as gross tumor volume (GTVboost) and irradiated to 40 Gy in 5 fractions. A current multicentre retrospective study across 16 European centres of 363 patients with a macroscopic recurrence identified on functional imaging showed that when the prescribed dose on the lesion was ≥ 72 Gy, an improvement in 5-year progression-free survival could be observed (72.8% (95 %CI 64.6–79.4) versus 60.3% (95 %CI 48.4; 70.3; P = 0.03), with an acceptable toxicity profile [46] . Ultimately, most of the panel would consider a moderate dose-escalation on the GTV, irrespective of the fractionation regimen for standard to hypofractionation, provided that OAR constraints were prioritized over the focal boost.…”

Section: Discussionmentioning

confidence: 97%

ESTRO ACROP consensus recommendation on the target volume definition for radiation therapy of macroscopic prostate cancer recurrences after radical prostatectomy

Dirix,

Dal Pra,

Khoo

et al. 2023

Clinical and Translational Radiation Oncology

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Section: Discussionmentioning

confidence: 97%

ESTRO ACROP consensus recommendation on the target volume definition for radiation therapy of macroscopic prostate cancer recurrences after radical prostatectomy

Dirix,

Dal Pra,

Khoo

et al. 2023

Clinical and Translational Radiation Oncology

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“…This is a single-arm, prospective, phase II multicentre study. According to the published prospective trials and retrospective series reporting the outcomes of the normo-fractionated sRT, we define biochemical relapse-free survival at 2 years of 60% as poor and of 80% as the promising outcome that would justify further investigation 30–33. We will, therefore, test the null hypothesis that the biochemical relapse-free survival at 2 years is lower than 60% against the alternative that it is at least 80%.…”

Section: Methodsmentioning

confidence: 99%

“…It is anticipated that increasing the dose per fraction would increase the therapeutic ratio and, thus, the potential tumour control. Nevertheless, considering the low toxicity rates reported, [29][30][31][32][33][34][35][36][37] using moderate hypofractionation in the postoperative setting with a daily RT dose of up to 3 Gy per fraction does not seem to corroborate this concern. However, the evidence on postoperative ultra-hypofractionated RT to the prostate bed is still in its early stages.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

HypoFocal SRT Trial: Ultra-hypofractionated focal salvage radiotherapy for isolated prostate bed recurrence after radical prostatectomy; single-arm phase II study; clinical trial protocol

Mathier,

Althaus,

Zwahlen

et al. 2024

BMJ Open

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IntroductionDespite radical prostatectomy (RP) and radiotherapy (RT) being established treatments for localised prostate cancer, a significant number of patients experience recurrent disease. While conventionally fractionated RT is still being used as a standard treatment in the postoperative setting, ultra-hypofractionated RT has emerged as a viable option with encouraging results in patients with localised disease in the primary setting. In addition, recent technological advancements in RT delivery and precise definition of isolated macroscopic recurrence within the prostate bed using prostate-specific membrane antigen-positron emission tomography (PSMA-PET) and multiparametric MRI (mpMRI) allow the exploration of ultra-hypofractionated schedules in the salvage setting using five fractions.Methods and analysisIn this single-arm prospective phase II multicentre trial, 36 patients with node-negative prostate adenocarcinoma treated with RP at least 6 months before trial registration, tumour stage pT2a–3b, R0–1, pN0 or cN0 according to the UICC TNM 2009 and evidence of measurable local recurrence within the prostate bed detected by PSMA PET/CT and mpMRI within the last 3 months, will be included. The patients will undergo focal ultra-hypofractionated salvage RT with 34 Gy in five fractions every other day to the site of local recurrence in combination with 6 months of androgen deprivation therapy. The primary outcome of this study is biochemical relapse-free survival at 2 years. Secondary outcomes include acute side effects (until 90 days after the end of RT) of grade 3 or higher based on Common Terminology Criteria for Adverse Events V.5, progression-free survival, metastasis-free survival, late side effects and the quality of life (based on European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30, QLQ-PR25).Ethics and disseminationThe study has received ethical approval from the Ethics Commission of the Canton of Bern (KEK-BE 2022-01026). Academic dissemination will occur through publications and conference presentations.Trial registration numberNCT05746806.

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“…Another study investigated dose-escalation in patients with a positive MRI after prostatectomy. Benziane-Ouaritini ( 21 ) et al. found that dose of ≥72 Gy showed better progression free survival on multivariate analysis.…”

Section: Do We Need To Increase the Dose In Postoperative Radiotherap...mentioning

confidence: 99%

Can PSMA PET/CT help in dose-tailoring in post-prostatectomy radiotherapy?

Champion,

Zwhalen,

Oehler

et al. 2023

Front. Oncol.

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There are few randomized trials to evaluate the use of PSMA-PET in the planning of post-prostatectomy radiotherapy. There are two unresolved questions 1) should we increase the dose to lesions visible on PSMA-PET 2) can we reduce dose in the case of a negative PSMA-PET. In this review, we summarize and discuss the available evidence in the literature. We found that in general, there seems to be an advantage for dose-increase, but ta large recent study from the pre-PSMA era didn’t show an advantage for dose escalation. Retrospective studies have shown that conventional doses to PSMA-PET-positive lesions seem sufficient. On the other hand, in the case of a negative PSMA-PET, there is no evidence that dose-reduction is possible. In the future, the combination of PSMA-PET with genomic classifiers could help in better identify patients who might benefit from either dose- de-or -increase. We further need to identify intraindividual references to help identify lesions with higher aggressiveness.

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Prostatectomy Bed Image-guided Dose-escalated Salvage Radiotherapy (SPIDER): An International Multicenter Retrospective Study

Cited by 8 publications

References 36 publications

ESTRO ACROP consensus recommendation on the target volume definition for radiation therapy of macroscopic prostate cancer recurrences after radical prostatectomy

ESTRO ACROP consensus recommendation on the target volume definition for radiation therapy of macroscopic prostate cancer recurrences after radical prostatectomy

HypoFocal SRT Trial: Ultra-hypofractionated focal salvage radiotherapy for isolated prostate bed recurrence after radical prostatectomy; single-arm phase II study; clinical trial protocol

Can PSMA PET/CT help in dose-tailoring in post-prostatectomy radiotherapy?

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