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

Jereczek‐Fossa, Barbara Alicja; Rojas, Damaris Patricia; Zerini, Dario; Fodor, C.; Viola, Anna; Fanetti, Giuseppe; Volpe, Stefania; Luraschi, R.; Bazani, A.; Rondi, E.; Cattani, Federica; Vavassori, Andrea; Garibaldi, Cristina; Alessi, S.; Pricolo, Paola; Petralia, Giuseppe; Cozzi, Guido; Cobelli, Ottavio De; Musi, Gennaro; Orecchia, Roberto; Marvaso, Giulia; Ciardo, D.

doi:10.1259/bjr.20180494

Cited by 59 publications

(89 citation statements)

References 49 publications

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“…Our results in terms of BFFS and LC rates are in agreement with updated literature ( The largest series on salvage re-irradiation has been reported in a retrospective multicenter study recently published by Pasquier et al [30]. On a total of 100 cases of local relapse, 32 were treated with PPR with different radiation doses.…”

Section: Discussionsupporting

confidence: 91%

“…Several investigations evaluating the efficacy of salvage re-irradiation for locally recurrent PCa were published [20][21][22][23][24][25][26][27][28][29][30]; however, the comparability of our results with other reports is hindered by the different selection criteria adopted by the authors. Some papers included in the same case series patients with local recurrence of PCa after primary EBRT, after BRT or after salvage postprostatectomy radiotherapy [20][21][22][23][24][25][26][27][28][29][30]. In addition, investigations evaluating intraprostatic recurrence after primary EBRT reported re-irradiation with mixed approaches delivering radiation therapy to the entire prostatic gland or to hemi prostate or to part of the prostate [28][29][30].…”

Section: Discussionmentioning

confidence: 95%

“…Some papers included in the same case series patients with local recurrence of PCa after primary EBRT, after BRT or after salvage postprostatectomy radiotherapy [20][21][22][23][24][25][26][27][28][29][30]. In addition, investigations evaluating intraprostatic recurrence after primary EBRT reported re-irradiation with mixed approaches delivering radiation therapy to the entire prostatic gland or to hemi prostate or to part of the prostate [28][29][30]. In our retrospective cohort we included only patients who underwent EBRT as primary treatment and who were subsequently treated with PPR for an isolated intraprostatic recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Partial prostate re-irradiation for the treatment of isolated local recurrence of prostate cancer in patients previously treated with primary external beam radiotherapy: short-term results of a monocentric study

Matrone¹,

Revelant²,

Fanetti³

et al. 2021

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Many different therapeutic options are available for locally recurrent prostate cancer (PCa). However, standard treatment has not yet been established. We conducted a partial prostate reirradiation (PPR) program for the treatment of isolated and limited-size intraprostatic recurrences, in patients who previously underwent external beam radiation therapy (EBRT) as primary treatment for prostatic cancer (PCa). The analysis of this experience in terms of feasibility, toxicity, and efficacy is reported. The inclusion criteria of this retrospective analysis were: previous definitive EBRT, evidence of biochemical recurrence, radiological detection of isolated local relapse, and PPR as local salvage therapy. Gastrointestinal (GI) and genitourinary (GU) toxicities were registered according to the RTOG/EORTC criteria. Between July 2012 and May 2019, 44 patients were treated with PPR. All patients completed the planned treatment. The median follow-up was 25.4 months. Tumor progression was observed in 18 patients (40.9%). Two-year local control, biochemical failure-and clinical relapse-free survival rates were 90.1%, 58.3%, and 67.9%, respectively. The occurrence of biochemical failure after PPR is lower for patients with the time interval between the primary EBRT and first biochemical failure > 4 years; local control results strongly associated with a biologically effective dose (BED) at first EBRT > 177Gy. No acute grade 3 or greater toxic events were observed. Two late grade 3 GU toxicities were reported. Although retrospective in design, our study indicates that PPR appears as a feasible, well-tolerated, and effective salvage treatment for isolated local PCa recurrence. Long term data are required in order to confirm these results.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Partial prostate re-irradiation for the treatment of isolated local recurrence of prostate cancer in patients previously treated with primary external beam radiotherapy: short-term results of a monocentric study

Matrone¹,

Revelant²,

Fanetti³

et al. 2021

neo

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“…The SO algorithm has been successfully used to design plans for a variety of SRS/SBRT treatments [6][7][8][9][10] although the result of the entire process can be significantly slow due to its intrinsic sequential nature. In fact, when large volumes are involved or complex dose distributions are required such as in simultaneous integrated boost (SIB) cases, each step requires a lengthy optimization, making the whole process slower.…”

Section: Introductionmentioning

confidence: 99%

Novel inverse planning optimization algorithm for robotic radiosurgery: First clinical implementation and dosimetric evaluation

et al. 2019

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A novel optimization algorithm (VOLO™) for robotic radiosurgery in the Precision™ treatment planning system was evaluated for different SRS/SBRT treatments and compared with the previous Sequential Optimization (SO) algorithm. Materials and methods: Fifty cases of brain, spine, prostate and lung tumors previously optimized with SO, were re-planned with VOLO™ algorithm keeping the same prescription, collimator type and size, optimization shells, and blocking structures. The dosimetric comparison involved target coverage, conformity (CI), gradient (GI) and homogeneity indexes, specific indicators of dose to OARs and number of nodes, beams, MU and delivery time. For brain only, plans were IRIS-and MLC-based (10 each). The remaining 30 plans were all IRIS-based. Results: VOLO™ optimization was significantly superior for target coverage for prostate and spine, CI for brain, and for brain and urethra dose sparing. SO gave significantly better results for GI for prostate. VOLO™ showed a significantly steeper dose fall-off for brain MLC-based, while for prostate and spine SO was superior. For IRISbased plans, VOLO™ significantly reduced the nodes (36%), beams (14%), and MU (31%). This led to an average reduction of delivery time of 20% (from 8% for brain to 30% for prostate). For MLC-based plans, VOLO™ significantly increased the nodes and beams (42%) keeping the same number of MU. The averaged delivery time increased by 18%. Conclusions: With respect to SO, VOLO™ optimization algorithm provided better results in terms of delivery time for IRIS-based and of quality of dose distribution for MLC-based plans, respectively.

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“…After detection and localization of ILF after radiation therapy, multiple options for salvage therapy are available, including cryoablation and high-intensity focused ultrasound (HIFU) (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Outcomes from the Cryotherapy Online Data (COLD) registry showed a 5-year actuarial biochemical disease-free rates of ∼50% with focal/whole gland salvage cryoablation (40,41).…”

Section: Introductionmentioning

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

Cited by 59 publications

References 49 publications

Partial prostate re-irradiation for the treatment of isolated local recurrence of prostate cancer in patients previously treated with primary external beam radiotherapy: short-term results of a monocentric study

Partial prostate re-irradiation for the treatment of isolated local recurrence of prostate cancer in patients previously treated with primary external beam radiotherapy: short-term results of a monocentric study

Novel inverse planning optimization algorithm for robotic radiosurgery: First clinical implementation and dosimetric evaluation

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

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