Abstract
Simple SummaryStereotactic body radiotherapy, a type of high-precision radiotherapy delivering high doses within few treatment sessions has proven to be effective and well tolerated in prostate cancer patients treated with definite radiotherapy. This systematic review summarizes the available data and analyzes whether this modern treatment may routinely be offered to prostate cancer patients after radical prostatectomy.(1) Background: Prostate cancer is the most common cancer in men and can be treated with radical prostatectomy (RPE) or radiotherapy in the primary setting. Stereotactic radiotherapy (SBRT) has proven to be effective and well tolerated in this setting. However, if SBRT is an equally promising treatment option if applied in the adjuvant or salvage setting after RPE remains unknown. (2) Methods: We searched the PubMed and Embase databases with the following full-text queries in August 2021 for any combination of the terms “SBRT”, “prostate”, “adjuvant”, “postoperative”, “salvage”, “stereotactic radiotherapy”, “prostate bed”. There were no limitations regarding publication date or language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. (3) Results: We identified 11 individual studies that were included in this systematic review. Three publications included patients without prior radiotherapy and the remaining eight patients with prior radiotherapy. In all but two publications the radiation target was the macroscopic recurrence. SBRT was overall well tolerated with acceptable rates of acute and late gastrointestinal or genitourinary toxicity. Quality of life was published for two phase I trials with good results. There was a very heterogeneous reporting on biochemical control after SBRT. (4) Conclusions: At this point, ultra-hypofractionated RT using SBRT to the prostate bed remains experimental and its use should be restricted to clinical trials. Given the biological rationale for extreme hypofractionation in patients with prostate cancer and the acceptable toxicity rates that have been reported, further exploration of this field is warranted.
Highlights
In patients with prostate cancer, both radical prostatectomy (RP) and radiation therapy (RT) are possible local treatment options in case of localized disease [1].After any local therapy, 30–60% of patients will develop recurrent disease [2,3]
The intervention was defined as stereotactic body radiotherapy (SBRT) to either the entire prostate bed or a macroscopic tumor recurrence in the prostate bed
Of the remaining 234 records used for screening, 16 papers included data on patients treated with SBRT of/in the prostate bed while 218 papers were removed during this step
Summary
In patients with prostate cancer, both radical prostatectomy (RP) and radiation therapy (RT) are possible local treatment options in case of localized disease [1].After any local therapy, 30–60% of patients will develop recurrent disease [2,3]. In patients with prostate cancer, both radical prostatectomy (RP) and radiation therapy (RT) are possible local treatment options in case of localized disease [1]. Several large randomized controlled trials have shown a benefit of adjuvant RT in patients with a high risk of local recurrence after RP, e.g., pT3 disease or positive resection margins [4,5,6,7,8]. In the setting of curative treatment for localized prostate cancer, use of ultra-hypofractionated RT delivered by stereotactic body radiotherapy (SBRT) has been established as a treatment option in patients with low- or intermediate-risk. Data on SBRT in high-risk patients are emerging with several large trials showing encouraging results [18,21,22,23,24,25,26]
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