Stereotactic Re-Irradiation for Local Recurrence after Radical Prostatectomy and Radiation Therapy: A Retrospective Multicenter Study

Perennec, Tanguy; Vaugier, L.; Tolédano, A.; Scher, N.; Thomin, Astrid; Pointreau, Y.; Janoray, G.; Crevoisier, R. de; Supiot, S.

doi:10.3390/cancers13174339

Cited by 9 publications

(12 citation statements)

References 28 publications

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“…According to the aforementioned latest systematic review of the literature [31], 18 articles are available in the current literature concerning salvage prostate Re-I, accounting for a total of 511 patients with a median follow-up of 22 months (range 9.6-77.6). However, more recent articles have been published in the last 2 years [60][61][62][63][64][65][66][67][68].…”

Section: Discussionmentioning

confidence: 99%

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

Cozzi

Ghersi

Bardoscia³

et al. 2023

Strahlenther Onkol

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Background The rates of local failure after curative radiotherapy for prostate cancer (PC) remain high despite more accurate locoregional treatments available, with one third of patients experiencing biochemical failure and clinical relapse occurring in 30–47% of cases. Today, androgen deprivation therapy (ADT) is the treatment of choice in this setting, but with not negligible toxicity and low effects on local disease. Therefore, the treatment of intraprostatic PC recurrence represents a challenge for radiation oncologists. Prostate reirradiation (Re-I) might be a therapeutic possibility. We present our series of patients treated with salvage stereotactic Re‑I for intraprostatic recurrence of PC after radical radiotherapy, with the aim of evaluating feasibility and safety of linac-based prostate Re‑I. Materials and methods We retrospectively evaluated toxicities and outcomes of patients who underwent salvage reirradiation using volumetric modulated arc therapy (VMAT) for intraprostatic PC recurrence. Inclusion criteria were age ≥ 18 years, histologically proven diagnosis of PC, salvage Re‑I for intraprostatic recurrence after primary radiotherapy for PC with curative intent, concurrent/adjuvant ADT with stereotactic body radiation therapy (SBRT) allowed, performance status ECOG 0–2, restaging choline/PSMA-PET/TC and prostate MRI after biochemical recurrence, and signed informed consent. Results From January 2019 to April 2022, 20 patients were recruited. Median follow-up was 26.7 months (range 7–50). After SBRT, no patients were lost at follow-up and all are still alive. One- and 2‑year progression free survival (PFS) was 100% and 81.5%, respectively, while 2‑year biochemical progression-free survival (bFFS) was 88.9%. Four patients (20%) experienced locoregional lymph node progression and were treated with a further course of SBRT. Prostate reirradiation allowed the ADT start to be postponed for 12–39 months. Re‑I was well tolerated by all patients and none discontinued the treatment. No cases of ≥ G3 genitourinary (GU) or gastrointestinal (GI) toxicity were reported. Seven (35%) and 2 (10%) patients experienced acute G1 and G2 GU toxicity, respectively. Late GU toxicity was recorded in 10 (50%) patients, including 8 (40%) G1 and 2 (10%) G2. ADT-related side effects were found in 7 patients (hot flashes and asthenia). Conclusion Linac-based SBRT is a safe technique for performing Re‑I for intraprostatic recurrence after primary curative radiotherapy for PC. Future prospective, randomized studies are desirable to better understand the effectiveness of reirradiation and the still open questions in this field.

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Section: Discussionmentioning

confidence: 99%

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

Cozzi

Ghersi

Bardoscia³

et al. 2023

Strahlenther Onkol

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“…Because of a low α/β ratio in prostate cancer, stereotactic body radiation therapy (SBRT) appears to be a non-invasive alternative allowing the management of relapses in irradiated areas while limiting the risk of local toxicity, according to retrospective studies (14,(29)(30)(31)(32)(33)(34)(35). In addition to the radiobiological bene t of which thirteen patients had evidence of a prostatic bed relapse, with nine in the re-irradiated territory.…”

Section: Discussionmentioning

confidence: 99%

“…Curative strategies including surgery, brachytherapy, HIFU or cryotherapy are feasible, but lack a good level of evidence (11)(12)(13). More recently, salvage stereotactic prostate bed radiotherapy was shown to be feasible with acceptable toxicity and encouraging e cacy results in retrospective studies (5,14).…”

Section: Introductionmentioning

confidence: 99%

REPAIR_GETUG P16 - Relapse in previously irradiated Prostate bed: a phase I/II study of stereotactic Ablative reirradiation potentiated by Metformine study protocol

Joly,

Blanc-Lapierre,

Rio

et al. 2023

Preprint

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Introduction: Salvage prostatic bed radiotherapy (PBRT) is a standard in case of biochemical recurrence following radical prostatectomy (RP) for prostate cancer. The management of isolated prostatic bed recurrence following RP and PBRT is debated. Reirradiation within stereotactic body radiotherapy (SBRT) guided by metabolic imaging could be a relevant option in this case. In parallel, metformin, an economically viable and well-tolerated oral antidiabetic agent, has demonstrated its radiosensitizing properties. This phase I/II clinical trial aims to i) determine the optimal dose for SBRT reirradiation, ii) conduct safety assessments, and iii) evaluate the efficacy of the metformin and SBRT combination. Methods and Analysis: We conduct a prospective, non-randomized, open-label, multicenter, dose escalation, phase I/II study involving a minimum of 44 patients. Eligible patients must have biochemical recurrence (PSA > 0.2 ng/ml and confirmed ascending trend in at least 2 successive assays), occurring at least 2 years after PBRT and prior RP for prostate cancer (including low, intermediate, and high risk with a single risk factor) and no CTCAE grade >=3 toxicity following PBRT. The recurrence should be visible on MRI and/or PET Choline and/or PET PSMA, without evidence of pelvic lymph node recurrence or metastatic disease. The primary objective of the phase I is to determine the optimal SBRT dose (5×6, 6×6, or 5×5 Gy) based on dose-limiting toxicity (DLT). The dose will be chosen using a time-to-event continual reassessment method based on DLT, defined as CTCAE grade ≥3 gastrointestinal or genitourinary toxicity, or any other grade 4 adverse event. The primary outcome of the phase II is to estimate the efficacy of SBRT in combination with metformin in terms of biological relapse-free survival (bRFS) rate at 3 years. Secondary outcomes include 5-year bRFS rate, early/late genitourinary and gastrointestinal toxicities, quality of life, biochemical response rate, clinical progression-free survival, and overall survival. Ethics and Dissemination: Ethical approval has been obtained from the Ethics committee "SUD EST III Bron" and the National Agency for the Safety of Medicines (ANSM). The study's findings will be disseminated through publications and conference presentations.

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“…Moreover, recent data demonstrated that dose escalation (72 Gy) was not associated with PFS improvement compared with 66 Gy regimen ( 32 ). Ablative treatment of local recurrence in the PB after RP followed by RT is also an attractive strategy but, may generate significant toxicity rates and prospective studies are needed to evaluate its effectiveness ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Mapping of Recurrence Sites Following Adjuvant or Salvage Radiotherapy for Prostate Cancer Patients

et al. 2022

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IntroductionAlthough salvage and adjuvant radiotherapy (RT) are effective in prostate cancer (PC) patients, 30%–40% of men will have disease progression. The objective was to describe the pattern of recurrence in PC patients with biochemical failure (BF) following postoperative RT.MethodsWe retrospectively analyzed 935 PC patients treated from 2009 to 2019 with adjuvant or salvage RT at the Institut de Cancérologie de l’Ouest. Of these, 205 (22%) developed BF of whom 166 underwent imaging. Patients with identified radiologic failure prior any specific treatment were included to determine the site of relapse categorized as local (L)-only, locoregional (LR), or metastatic (M) recurrence. Main disease characteristics and RT fields were examined in relation to sites of recurrence.ResultsOne hundred forty-one patients were identified with 244 sites of failure on imaging. Of these, 108 patients had received RT to the PB alone and 33 RT to the PB and pelvic lymph nodes (PB+PLN). Androgen-deprivation therapy was used concomitantly in 50 patients (35%). The median PSA at imaging was 1.6 ng/ml (range, 0–86.7). In all, 74 patients (52%) had M disease (44% in the PB group and 79% in the PB+PLN group), 61 (43%) had LR failure (52% in the PB alone group and 15% in the PB+PLN group), and six (4%) had L-only failure, at a median of 26.7 months (range, 5–110.3) from RT. Metastases were in extra-pelvic LN (37 (15%)), bones (66 (27%)), and visceral organs (eight (3%)). Fifty-three (48%) of the pelvic LN failures in the PB group would have been encompassed by standard PLN RT volume.ConclusionWe found that most patients evaluated for BF after postoperative RT recurred outside the RT field. Isolated pelvic nodal failure was rare in those receiving RT to the PB+PLN but accounted for half of failures in those receiving PB alone RT. Imaging directed salvage treatment could be helpful to personalize radiation therapy plan.

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Stereotactic Re-Irradiation for Local Recurrence after Radical Prostatectomy and Radiation Therapy: A Retrospective Multicenter Study

Cited by 9 publications

References 28 publications

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

REPAIR_GETUG P16 - Relapse in previously irradiated Prostate bed: a phase I/II study of stereotactic Ablative reirradiation potentiated by Metformine study protocol

Mapping of Recurrence Sites Following Adjuvant or Salvage Radiotherapy for Prostate Cancer Patients

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