Abstract
Simple SummaryStereotactic body radiation therapy remains an understudied treatment option for local recurrence in the prostate bed after prostatectomy followed by radiation therapy. Ablative treatment of local recurrence could avoid or delay androgen deprivation therapy or next-generation antiandrogens. This study suggests that this treatment modality could be a valuable option if confirmed by a prospective study, but long-term toxicity may be a significant limitation.Prostate cancer recurrence in patients previously treated with radical prostatectomy and radiation therapy is challenging. Re-irradiation could be an option, but data regarding efficacy and safety are lacking. We retrospectively evaluated salvage re-irradiation for local recurrence after prostatectomy and external beam radiation therapy. We collected data from 48 patients who underwent salvage reirradiation with stereotactic radiation therapy for local prostate cancer recurrence in the prostatic bed at four French centers. Fifteen patients (31%) were on androgen deprivation therapy during stereotactic radiotherapy. Biochemical response and relapse-free survival were analyzed, and post-treatment toxicities were assessed according to the Common Terminology of Adverse Events criteria. Five patients had grade 3 late bladder toxicity (cystitis), three had grade 3 late incontinence, and one had grade 3 late chronic pain. At three months, 83% of patients had a positive biochemical response. The median follow-up was 22 months. At the end of the follow-up, 21 patients (43%) had a biochemical relapse. The median time to biologic relapse was 27 months. The biochemical relapse rates at 1 and 2 years were 80% and 52%, respectively. In conclusion, salvage re-irradiation for recurrent prostate cancer in the prostate bed may generate significant toxicity rates, and a prospective study with appropriate patient selection is needed to evaluate its effectiveness.
Highlights
Prostate cancer is the third most frequently diagnosed and eighth-deadliest cancer worldwide, according to the Global Cancer Project (GLOBOCAN) report, which estimated 1,276,106 new cases and 358,989 deaths in 2018 [1]
We retrospectively collected data from all patients treated with Stereotactic body radiation therapy (SBRT) for local prostate cancer recurrence after radical prostatectomy and radiotherapy in four French radiotherapy departments in Nantes, Tours, Rennes, and Levallois
The patients initially selected had to meet the following inclusion criteria: localized prostate cancer treated by radical prostatectomy followed by radiotherapy, in strict local recurrence proven by MRI, choline PET-CT, or PSMA PET-CT
Summary
Prostate cancer is the third most frequently diagnosed and eighth-deadliest cancer worldwide, according to the Global Cancer Project (GLOBOCAN) report, which estimated 1,276,106 new cases and 358,989 deaths in 2018 [1]. ADT alone is recommended in case of additional recurrence, delayed if the risk of metastatic disease is low (PSA doubling time superior to 10 months), and associated with modern antiandrogen in the eventuality of a new progression [2,10,11]. Stereotactic body radiation therapy (SBRT) is a radiotherapy technique that allows for high doses per fraction with a high dose gradient This technique could be interesting at the first recurrence after radiation therapy or later at relapse under ADT. SBRT could preserve the adjacent organs and take advantage of the low alpha/beta ratio of prostate cancer [14,15] It may be a new curative therapeutic option to avoid or delay ADT, castration resistance, and pejorative events. We aimed to evaluate the safety and efficacy of the re-irradiation of a local recurrence in the prostatic bed
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