Macroscopic Locoregional Relapse from Prostate Cancer: Which Role for Salvage Radiotherapy?

Overview

Journal Clin Transl Oncol

Specialty Oncology

Date 2019 Mar 15

PMID 30868389

Citations 11

Authors

A Bruni

G Ingrosso

F Trippa

M Di Staso

B Lanfranchi

L Rubino

S Parente

L Frassinelli

E Maranzano

R Santoni

M C Sighinolfi

F Lohr

E Mazzeo

Affiliations

Soon will be listed here.

Abstract

Introduction: Salvage radiotherapy (SRT) after radical prostatectomy for prostate cancer (PCa) is recommended as soon as PSA rises above 0.20 ng/ml, but many patients (pts) still experience local macroscopic relapse. The aim of this multicentric retrospective analysis was to evaluate the role of SRT in pts with macroscopic relapse.

Materials And Methods: From 2001 to 2016, 105 consecutive pts with macroscopic PCa relapse underwent SRT ± androgen deprivation therapy (ADT). Mean age was 72 years. At time of relapse, 29 pts had a PSA value < 1.0 ng/mL, 50 from 1.1 to 5, and 25 pts > 5. Before SRT, 23 pts had undergone 18F-choline PET and 15 pts pelvic MRI. Ninety-four pts had prostatic bed relapse only, and four nodal involvement. Fifty-one pts were previously submitted to first-line ADT, while 6 pts received ≥ 2 lines.

Results: At a median follow-up of 52 months, 89 pts were alive, while 16 were dead. Total RT dose to macroscopic lesions was > 70 Gy in 58 pts, 66-70 Gy in 43, and < 66 Gy in 4 pts. In 72 pts, target volume encompassed only the prostatic bed with sequential boost to macroscopic site; 33 pts received prophylactic pelvic RT. Ten-year overall survival was 76.1%, while distant metastasis-free survival was 73.3%. No grade 4-5 toxicities were found.

Conclusions: SRT ± ADT for macroscopic relapse showed a favorable oncological outcome supporting its important role in this scenario. Data from this series suggest that SRT may either postpone ADT or improve results over ADT alone in appropriately selected pts.

Citing Articles

Image-Guided Stereotactic Body Radiotherapy on Detectable Prostate Bed Recurrence after Prostatectomy in RT-Naïve Patients.

Santamaria R, Zaffaroni M, Vincini M, Colombi L, Gaeta A, Mastroleo F Life (Basel). 2024; 14(7).

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ESTRO ACROP consensus recommendation on the target volume definition for radiation therapy of macroscopic prostate cancer recurrences after radical prostatectomy.

Dirix P, Dal Pra A, Khoo V, Carrie C, Cozzarini C, Fonteyne V Clin Transl Radiat Oncol. 2023; 43:100684.

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Three Months' PSA and Toxicity from a Prospective Trial Investigating STereotactic sAlvage Radiotherapy for Macroscopic Prostate Bed Recurrence after Prostatectomy-STARR (NCT05455736).

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Dose-Escalated Salvage Radiotherapy for Macroscopic Local Recurrence of Prostate Cancer in the Prostate-Specific Membrane Antigen Positron Emission Tomography Era.

Tamihardja J, Zehner L, Hartrampf P, Cirsi S, Wegener S, Buck A Cancers (Basel). 2022; 14(19).

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Hypofractionated Postoperative Radiotherapy in Prostate Cancer with Ialuril Soft Gels: Toxicity and Efficacy Analysis on a Retrospective Series of 305 Patients.

Nicosia L, Vitale C, Cuccia F, Figlia V, Giaj-Levra N, Mazzola R Cancer Manag Res. 2022; 14:2839-2846.

PMID: 36164468 PMC: 9508891. DOI: 10.2147/CMAR.S357814.

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