Abstract
Objectives: To report the preliminary results of salvage re-irradiation in the prostatic bed after radical prostatectomy and salvage external beam radiation therapy (EBRT) using robotic stereotactic body radiation therapy (SBRT) with Cyberknife® for local recurrence of prostate cancer.Materials and Methods: Retrospective monocentric analysis was performed on patients treated with SBRT for isolated macroscopic recurrence in the prostatic bed. All patients had radical prostatectomy and salvage or adjuvant EBRT. Local recurrence was documented using magnetic resonance imaging (MRI) and positron emission tomography (PET). Biochemical recurrence was defined as 2 rises in prostate-specific antigen (PSA) of ≥ 0.2 ng/mL above nadir. Internal gold fiducials were used for the tracking of tumor motion during SBRT. The prescription dose was 36 Gy in 6 fractions for all patients. Toxicity was scored according to the CTCAE v4.0.Results: Between July 2011 and November 2017, 12 patients were treated with SBRT for prostatic bed recurrence with a median follow-up of 34.2 (range, 3.5–64.4) months. Isolated non-metastatic recurrence in the prostatic bed was seen at MRI and PET imaging. Two patients were treated with 6 months androgen deprivation therapy (ADT) concomitant with re-irradiation. The median planning target volume was 4.5 cm3 (range, 1.2–13.3). A PSA decrease after SBRT was found in 10 (83%) patients. The 1 and 2 years biochemical recurrence-free survival rates were 79 and 56%, respectively. Biochemical recurrence was observed for 6 patients (50%) after a median time of 18 (4-42) months. Toxicity showed: 3 patients (25%) with grade 1 cystitis and 1 patient (8%) with acute grade 2 proctitis at 4 months. One patient (13%) had grade 1 cystitis at 12 months.Conclusion: Re-irradiation for local recurrence in the prostatic bed using Cyberknife® after surgery and salvage or adjuvant EBRT is well-tolerated and associated with 2 years biochemical recurrence-free survival rates of 56%. Longer follow-up and larger series are necessary.
Highlights
Prostate cancer (PCa) is the most common cancer in men in western countries and radical prostatectomy (RP) remains one of the standard-of-care treatment options for localized cancers [1]
We report our preliminary results of salvage re-irradiation Stereotactic body radiation therapy (SBRT) using Cyberknife R (Accuray Incorporated, Sunnyvale, California) in the prostatic bed for local recurrences of PCa
Between July 2011 and October 2017, 12 consecutive patients were treated with SBRT for a local recurrence after RP and salvage or adjuvant External beam radiation therapy (EBRT) using the CyberKnife R System at the Oscar Lambret Comprehensive Cancer Center (Lille, France) as decided in a multidisciplinary meeting
Summary
Prostate cancer (PCa) is the most common cancer in men in western countries and radical prostatectomy (RP) remains one of the standard-of-care treatment options for localized cancers [1]. Despite new surgical approaches using robotics to optimize outcomes, the rate of biochemical recurrence (BCR), defined by a serum prostate-specific antigen (PSA) level >0.2 ng/mL, after primary RP remains around 20–30% [2, 3]. When PSA level increases after RP, investigations are needed to differentiate local recurrences from distant metastases. More than 50% of these recurrences are local and the most common option for local salvage therapy after RP is radiation therapy [4]. 45–65% of men treated using salvage radiation therapy after RP will experience a second BCR at 5 years [5]
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