High-dose-rate stereotactic body radiation therapy for postradiation therapy locally recurrent prostatic carcinoma: Preliminary prostate-specific antigen response, disease-free survival, and toxicity assessment

Fuller, Donald B.; Wurzer, James C.; Shirazi, Reza; Bridge, Stephen S.; Law, Jonathan; Mardirossian, G.

doi:10.1016/j.prro.2015.04.009

Cited by 52 publications

(74 citation statements)

References 34 publications

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“…The dose used in our series is higher than that described by Jereczek-Fossa et al (30 Gy in five fractions), which has been described as being too low [28, 29], and lower than that applied in the study by Fuller et al [29], which was consistent with this team’s own practice (heterogeneous prescription similar to high-dose-rate brachytherapy).…”

Section: Discussionsupporting

confidence: 85%

Salvage robotic SBRT for local prostate cancer recurrence after radiotherapy: preliminary results of the Oscar Lambret Center

et al. 2017

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BackgroundCurrently, there is no standard option for local salvage treatment for local prostate cancer recurrence after radiotherapy. Our objective was to investigate the feasibility and efficiency of Robotic Stereotactic Body Radiation Therapy (SBRT) in this clinical setting.Methods/materialsWe retrospectively reviewed patients who were treated at our institution with SBRT for local prostate cancer recurrence after External Beam Radiation Therapy (EBRT) or brachytherapy.Multidisciplinary staff approved the treatment, and recurrence was biopsy-proven when feasible. A dose of 36 Gy was prescribed in six fractions. Treatment was delivered every other day.ResultsBetween August 2011 and February 2014, 23 patients were treated with SBRT for intra-prostate cancer recurrence with a median follow up of 22 months (6 to 40).Twenty patients had biopsy-proven recurrence.For 19 patients, EBRT was the initial treatment and in four patients, brachytherapy was the initial treatment; the median relapse-time from initial treatment was 65 months (28 to 150).At relapse, 10 patients had an extra-capsular extension.Fourteen patients were treated with androgen deprivation that could be stopped after a median of 1 month after SBRT (range 0–24).A PSA decrease occurred in 82.6% of the patients after SBRT.The 2-year disease-free survival and overall survival rates were 54 and 100%, respectively.Disease progression was observed for nine patients (39.1%) (five local, three metastatic and one nodal progression) after a median of 20 months (7–40 months).The median nadir PSA was 0.35 ng/ml and was achieved after a median of 8 months (1 to 30) after treatment.We observed no grade 4 or 5 toxicity. Two patients presented with grade 3 toxicities (two Cystitis and one neuralgia). Other toxicities included urinary toxicities (five grade 2 and nine grade 1) and rectal toxicities (two grade 2 and two grade 1).ConclusionSBRT for local prostate cancer recurrence seems feasible and well tolerated with a short follow up. Prospective evaluation is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-017-0833-9) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 85%

Salvage robotic SBRT for local prostate cancer recurrence after radiotherapy: preliminary results of the Oscar Lambret Center

et al. 2017

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“…Since then, Fuller et al published a retrospective study including 29 patients treated with a total dose of 34 Gy in 5 fractions within a median follow-up of 24 months. They reached an actuarial 2-year BCR-free survival of 82% with only 7% of grade 3–4 urinary toxicity and no severe digestive toxicity [20]. …”

Section: Discussionmentioning

confidence: 99%

“…Reported 2-year BCR-free survival are around 50% for both radiation modalities [13–20]. The aim of this study was to evaluate the clinical outcomes (efficacy and toxicity) of salvage HDRB or SBRT (CyberKnife®, Accuracy, Sunnyvale, CA, USA) in patients with post-radiation local recurrence of prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

Salvage prostate re-irradiation using high-dose-rate brachytherapy or focal stereotactic body radiotherapy for local recurrence after definitive radiation therapy

et al. 2017

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BackgroundOptimal management of locally recurrent prostate cancer after definitive radiation therapy is still challenging. With the development of highly accurate radiotherapy devices, prostate salvage re-irradiation might generate lower toxicity rates than classical salvage therapies. We retrospectively evaluated the toxicity and the feasibility of a prostate re-irradiation after definitive radiation therapy failure. Two modalities were investigated: high-dose-rate brachytherapy (HDRB) on whole prostate gland and focal stereotactic radiotherapy (SBRT) using CyberKnife® linac.MethodsBetween 2011 and 2015, 28 patients with imaged and/or biopsy-proven intra-prostatic recurrence of cancer after definitive radiation therapy underwent a salvage re-irradiation using HDRB (n = 10) or focal SBRT (n = 18). The schedule of re-irradiation was 35 Gy in 5 fractions.Biological response (defined as post-salvage radiation PSA variation) and biochemical no-evidence of disease (bNED) were evaluated in the whole cohort. For patients who had a positive biological response after salvage radiation, biochemical recurrence (BCR) and survival after salvage radiotherapy were evaluated. Post-salvage toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.03 and were compared to baseline status.ResultsWithin a median follow-up of 22.5 months (IQR = 8–42), 9 (90%) patients experienced a positive biological response after salvage HDRB and 5 (50%) remained bNED at the end of the follow-up. Among patients who initially responded to salvage HDRB, the BCR rate was 44.4% after a median interval of 19.5 months (IQR = 11.5–26). Only one patient experienced a transient grade 3 urinary complication.In the SBRT group, the median follow-up was 14.5 months (IQR = 7–23) and 10 (55.6%) out of the 18 patients remained bNED. Among the 15 patients who initially responded to salvage SBRT, 5 (33.3%) experienced a BCR. One patient experienced a transient grade 4 urinary complication.At the end of the follow-up, all evaluated patients had a urinary status grade variation ≤ +1 grade. No grade 3–4 digestive toxicity was observed.ConclusionsSalvage prostate re-irradiation for locally recurrent cancer is feasible and generate low toxicities rates when using with HDRB or focal SBRT. However, further investigations are necessary to confirm these findings and to determine predictive features for patients who might benefit from such an approach.

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“…This, in turn, would support using a focal approach, as long as it is oncologically isoeffective to a WG approach. Fuller et al 32 recently published the results of a prospective study of 29 patients treated with salvage SBRT with 34 Gy in five fractions. Late CTCAE grade $3 toxicity was seen in two patients, one of whom had received prior LDR.…”

Section: Discussionmentioning

confidence: 99%

“…In the reirradiation setting, however, rates of long-term adverse are likely to be higher, and clinical data are still emerging. Several recent series [30][31][32] exploring the outcomes of salvage SBRT in this setting have reported late CTCAE grade $3 GU toxicity rates after salvage SBRT approach of 7%. The purpose of this study was to assess the magnitude of the dosimetric advantages offered by performing HG prostate SBRT, with the hypothesis that the dosimetric benefits would be large enough to suggest a clinical benefit, particularly in the salvage setting.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric benefits of hemigland stereotactic body radiotherapy for prostate cancer: implications for focal therapy

Kishan

Park

King

et al. 2015

BJR

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Objective: Compared with standard, whole-gland (WG) therapies for prostate cancer, focal approaches may provide equivalent oncologic outcomes with fewer adverse effects. The purpose of this study was to compare organ-at-risk (OAR) dosimetry between hemigland (HG) and WG stereotactic body radiotherapy (SBRT) plans. Methods: Volumetric-modulated arc radiotherapy-based SBRT plans were designed to treat the left HG, right HG and WG in eight patients, using five fractions of 8 Gy. OARs of interest included the contralateral HG, rectum, urinary bladder, urethra, penile bulb and contralateral neurovascular bundle. Results: Rectal V 80% (the percentage of a normal structure receiving a dose of 80%) and V 90% were significantly lower with HG plans than with WG plans (median values of 4.4 vs 2.5 cm 3 and 2.1 vs 1.1 cm 3 , respectively, p , 0.05 by Student's t-test). Bladder V 50% was also reduced significantly in HG plans (32.3 vs 17.4 cm 3 , p , 0.05), with a trend towards reduction of V 100% (3.4 vs 1.3 cm 3

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High-dose-rate stereotactic body radiation therapy for postradiation therapy locally recurrent prostatic carcinoma: Preliminary prostate-specific antigen response, disease-free survival, and toxicity assessment

Cited by 52 publications

References 34 publications

Salvage robotic SBRT for local prostate cancer recurrence after radiotherapy: preliminary results of the Oscar Lambret Center

Salvage robotic SBRT for local prostate cancer recurrence after radiotherapy: preliminary results of the Oscar Lambret Center

Salvage prostate re-irradiation using high-dose-rate brachytherapy or focal stereotactic body radiotherapy for local recurrence after definitive radiation therapy

Dosimetric benefits of hemigland stereotactic body radiotherapy for prostate cancer: implications for focal therapy

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