Salvage Stereotactic Body Radiation Therapy for Local Prostate Cancer Recurrence After Radiation Therapy: A Retrospective Multicenter Study of the GETUG

Pasquier, David; Martinage, Geoffrey; Janoray, G.; Rojas, Damaris Patricia; Zerini, Dario; Goupy, F.; Crevoisier, R. de; Bogart, Émilie; Calais, G.; Tolédano, A.; Chauveinc, L.; Scher, N.; Bondiau, P.-Y.; Hannoun-Lévi, J.-M.; Silva, Marlon; Meyer, E.; Nickers, Philippe; Lacornerie, T.; Jereczek‐Fossa, Barbara Alicja; Lartigau, Éric

doi:10.1016/j.ijrobp.2019.07.012

Cited by 56 publications

(67 citation statements)

References 33 publications

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“… 56 Two studies in our review also found improved BRFS when a BED of ≥130 Gy (α/β = 1.5, ≥30 Gy in 5 fractions, 85% vs 60%, P = .0006) 34 and >120 Gy (α/β = 2, >30 Gy in 5 fractions, hazard ratio 0.41, 95% CI, 0.20–0.86, P = .018) was used. 37 This supports the notion that a therapeutic dose of RT should be considered in re-RT. Decreasing length of follow-up was associated with improvements in LC and BRFS, in addition to decreased late toxicity rates, suggesting that outcomes reported in our review are not mature and longer follow-up is necessary before definitive statements can be made.…”

Section: Discussionsupporting

confidence: 76%

“…Nineteen full text publications met our eligibility criteria, representing 13 patient data cohorts with 428 patients. 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 Nineteen studies were included in the qualitative portion of our systematic review, and the 13 separate patient data cohorts were included when reporting oncologic outcomes, toxicity, and the quantitative meta-analysis. Only 1 study was prospective, 27 and the remainder were retrospective.…”

Section: Resultsmentioning

confidence: 99%

“… 33 Ten studies used PET imaging before re-RT, and 6 studies had ≥95% of patients undergoing PET. 31 , 32 , 35 , 36 , 37 , 38 …”

Section: Resultsmentioning

confidence: 99%

“…Scher et al 38 used a rectal spacer in 23 patients, and although significantly lower rectal doses were achieved, no differences in acute and late toxicities were found. Pasquier et al 37 used a rectal spacer in 9 patients without reporting separate outcomes.…”

Section: Resultsmentioning

confidence: 99%

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A Novel Salvage Option for Local Failure in Prostate Cancer, Reirradiation Using External Beam or Stereotactic Radiation Therapy: Systematic Review and Meta-Analysis

Corkum

Mendez

Chin

et al. 2020

Advances in Radiation Oncology

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Purpose Reirradiation (re-RT) using external beam radiation therapy (EBRT) is a novel salvage strategy for local failure in prostate cancer. We performed a systematic review describing oncologic and toxicity outcomes for salvage EBRT/stereotactic radiation therapy (SBRT) re-RT. Methods and Materials A International Prospective Register of Systematic Reviews registered (#141466) systematic review, meta-analysis, and meta-regression was conducted using preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed and EMBASE were searched from inception through September 2019. Outcome measures included local control (LC), biochemical relapse free survival (BRFS), and ≥grade 3 genitourinary (GU)/gastrointestinal (GI) toxicity. EBRT and SBRT data were collected separately. Meta-regression explored disease and toxicity outcomes as a function of equivalent dose in 2 Gy fractions (EQD2), length of follow-up, and partial versus whole prostate reirradiation. Results Nineteen studies representing 13 cohorts were included (428 patients). Weighted mean follow-up was 26.1 months. Median re-RT EQD2 was 77.1 Gy (α/β = 1.5), with 92% of patients receiving SBRT, 52.1% of patients receiving partial prostate re-RT, and 30.1% of patients receiving androgen deprivation therapy with re-RT. LC was 83.2% (95% confidence interval [CI], 75.5%-90.9%) and BRFS was 59.3% (47.9%-70.7%). Reported late toxicity ≥grade 3 was 3.4% (95% CI, 1.0%-5.8%) for GU and 2.0% (95% CI, 0.1%-4.0%) for GI. Meta-regression found higher LC, BRFS, and reported GU/GI toxicity with increasing EQD2, with partial prostate re-RT associated with less reported GU/GI toxicity and no detriment to LC and BRFS. Conclusions Salvage re-RT using EBRT, particularly with SBRT, is an emerging technique to treat isolated local failure of prostate cancer. With short-term follow-up, LC, BRFS, and reported toxicities appear reasonable, although further follow-up is required before definitive statements on late toxicities can be made. Our review is limited by incomplete reporting of androgen deprivation therapy use in the primary literature. Further prospective studies and longer follow-up are needed before considering re-RT as standard practice.

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Section: Discussionsupporting

confidence: 76%

Section: Resultsmentioning

confidence: 99%

“… 33 Ten studies used PET imaging before re-RT, and 6 studies had ≥95% of patients undergoing PET. 31 , 32 , 35 , 36 , 37 , 38 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A Novel Salvage Option for Local Failure in Prostate Cancer, Reirradiation Using External Beam or Stereotactic Radiation Therapy: Systematic Review and Meta-Analysis

Corkum

Mendez

Chin

et al. 2020

Advances in Radiation Oncology

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“…There are also few salvage treatments for locoregional recurrent disease after radical prostate EBRT. Early toxicity results of re-irradiation salvage SBRT are favourable (68)(69)(70) and further research into MR-guided salvage re-irradiation may be useful.…”

Section: Opportunities For Future Development Of Mrgrt In Prostate Camentioning

confidence: 99%

MR-Guided Radiotherapy for Prostate Cancer

et al. 2020

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External beam radiotherapy remains the primary treatment modality for localized prostate cancer. The radiobiology of prostate carcinoma lends itself to hypofractionation, with recent studies showing good outcomes with shorter treatment schedules. However, the ability to accurately deliver hypofractionated treatment is limited by current image-guided techniques. Magnetic resonance imaging is the main diagnostic tool for localized prostate cancer and its use in the therapeutic setting offers anatomical information to improve organ delineation. MR-guided radiotherapy, with daily re-planning, has shown early promise in the accurate delivery of radiotherapy. In this article, we discuss the shortcomings of current image-guidance strategies and the potential benefits and limitations of MR-guided treatment for prostate cancer. We also recount present experiences of MR-linac workflow and the opportunities afforded by this technology.

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Salvage stereotactic body radiation therapy for locally recurrent prostate cancer following primary radiation therapy, are benefits worth toxicity risks?: A systematic review

2023

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Introduction: Salvage stereotactic body radiation therapy (SBRT) for localized prostate cancer recurrence following radiation therapy remains controversial. We performed a systematic review to assess the efficacy and side effect profile of salvage SBRT for locally recurrent prostate cancer to define the role of salvage SBRT in clinical practice.Methods: A systematic review was carried out using Pubmed (MEDLINE) and Scopus databases. Inclusion and exclusion criteria were satisfied if studies reported on patients with prior radiation therapy for prostate cancer who had subsequently had a local recurrence. Those studies included were quality assessed using the ROBINS-I checklist.Results: Five studies in total met criteria for inclusion and included all reportable outcomes. A total of 265 participants are reported on in total. Median doses for SBRT ranged from 30 to 36 Gy delivered over 5−6 fractions. Recurrence free survival ranged from 40% to 76% at 2 years. Genitourinary toxicity was more prevalent than gastrointestinal toxicities. Grade 2 and 3 genitourinary complication rates ranged from 5% to 22% and 0% to 9%, respectively. Gastrointestinal grade 2 complication rates ranged from 0% to 11% and no grade 3 complications were recorded.Discussion: Salvage SBRT appears to be comparable and potentially superior in some aspects to other salvage therapies, taking into account the limitations in cross-study comparisons. This systematic review serves as one of the first to characterize SBRT as a salvage option for locally recurrent prostate cancer.

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Salvage Stereotactic Body Radiation Therapy for Local Prostate Cancer Recurrence After Radiation Therapy: A Retrospective Multicenter Study of the GETUG

Cited by 56 publications

References 33 publications

A Novel Salvage Option for Local Failure in Prostate Cancer, Reirradiation Using External Beam or Stereotactic Radiation Therapy: Systematic Review and Meta-Analysis

A Novel Salvage Option for Local Failure in Prostate Cancer, Reirradiation Using External Beam or Stereotactic Radiation Therapy: Systematic Review and Meta-Analysis

MR-Guided Radiotherapy for Prostate Cancer

Salvage stereotactic body radiation therapy for locally recurrent prostate cancer following primary radiation therapy, are benefits worth toxicity risks?: A systematic review

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