Stereotactic Body Radiation Therapy Salvage Reirradiation of Radiorecurrent Prostatic Carcinoma Relapsed in the Prostatic Bed

Abstract

A 67-year-old man presented with a slow increase of prostate-specific antigen value after radical prostatectomy and postoperative radiotherapy for prostate cancer. The patient had received 3D conformal radiotherapy to a total dose of 66 Gy in 33 fractions of 2 Gy each on the prostatic bed. Three years later, a macroscopic local failure was diagnosed at the apical region. The patient could not receive androgenic deprivation therapy or other types of treatment owing to comorbid conditions. Thus, stereotactic body radiation therapy with helical image-guided tomotherapy was administered. The total dose was 30 Gy in 5 consecutive fractions of 6 Gy each to the site of the local failure. The treatment was preceded by a transperineal-guided injection of a self-absorbable hydrogel into the prostatic bed, between rectum and bladder, in order to preserve the rectal wall, which already had received significant doses from the first radiation course. Radiation therapy was well-tolerated. After a follow-up period of 6 months, the patient remains healthy, and there has been no further evidence of metastatic spread or recurrence.

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

“…Our excellent rates of GU and GI side effects confirm the good profile of toxicity reported also by other investigators in smaller series. 17,18,20,21,23,25 For example, Leroy et al 20 in a series of 23 patients treated with SBRT (36 Gy in 6 fractions) did not observe Grade 4 or 5 toxicity. Importantly, in our series no patient experienced urinary incontinence, a typical complication of other salvage local therapies.…”

“…The efficacy of salvage reirradiation for locally recurrent PCa has been evaluated by several investigations. [14][15][16][17][18][19][22][23][24][25][26][28][29][30][31][32][33][34] The first report on re-EBRT by Vavassori et al 15 including six cases treated by CyberKnife, showed the feasibility of reirradiation with an acceptable rate of acute and early chronic toxicity (median follow-up was 11.3 months). These preliminary findings were then confirmed by the successive series.…”

“…14,[16][17][18][19][28][29][30][31][32][33][34] All but one report concluded that salvage re-EBRT is safe. [14][15][16][17][18][19][20][21][23][24][25][26][27] Zilli et al 22 published the data of 14 patients treated with whole prostate reirradiation, with the median follow-up of 94 months, showing low acute but very high late GU and GI toxicity rates (29% of patients experienced combined Grade 4 GU/GI injury). Contrarily to the Zilli's series, we observed only 1 Grade 3 GU event among 20 males with follow-up >36 months.…”

“…7,12 As far as reirradiation is concerned, the vast majority of patient series were treated with brachytherapy (BRT). In the last years, along with the improvement in radiotherapy (RT) planning and delivery technology, several reports on salvage EBRT have been published [14][15][16][17][18][19][20][21][22][23][24][25][26][27] (Table 1).…”

Pelvic re-irradiation using stereotactic ablative radiotherapy (SABR): A systematic review

“…Several studies performed Positron Emission Tomography (PET) to exclude additional disease [7,[10][11][12][13][14][15]. In addition, seven studies used Magnetic Resonance Imaging-Computed Tomography (MRI-CT) co-registration to assist with target delineation [7,9,13,[15][16][17][18]. Most studies used body frames, vacuum bags or cradles for immobilisation.…”