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Cozzi S, Finocchi Ghersi S, Bardoscia L, Najafi M, Blandino G, Alì E, Augugliaro M, Vigo F, Ruggieri MP, Cardano R, Giaccherini L, Iori F, Botti A, Trojani V, Ciammella P, Iotti C. Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes. Strahlenther Onkol 2023; 199:554-564. [PMID: 36732443 DOI: 10.1007/s00066-023-02043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023]
Abstract
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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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy. .,Radiation Oncology Department, Centre Lèon Bèrard, Lyon, France.
| | - Sebastiano Finocchi Ghersi
- Radiation Oncolgy Unit, AOU Sant'Andrea, Facoltà di Medicina e Psicologia, Università La Sapienza, 00185, Rome, Italy
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healthcare Company Tuscany Nord Ovest, 55100, Lucca, Italy
| | - Masoumeh Najafi
- Skull Base Research Center, Iran University of Medical Science, 1997667665, Tehran, Iran
| | - Gladys Blandino
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Matteo Augugliaro
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Federica Vigo
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Raffaele Cardano
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Lucia Giaccherini
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Valeria Trojani
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
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A Novel Concept of Transperineal Focused Ultrasound Transducer for Prostate Cancer Local Deep Hyperthermia Treatments. Cancers (Basel) 2022; 15:cancers15010163. [PMID: 36612159 PMCID: PMC9818476 DOI: 10.3390/cancers15010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Design, embodiment, and experimental study of a novel concept of extracorporeal phased array ultrasound transducer for prostate cancer regional deep hyperthermia treatments using a transperineal acoustic window is presented. An optimized design of hyperthermia applicator was derived from a modelling software where acoustic and thermal fields were computed based on anatomical data. Performance tests have been experimentally conducted on gel phantoms and tissues, under 3T MRI guidance using PRFS thermometry. Feedback controlled hyperthermia (ΔT = 5 °C during 20min) was performed on two ex vivo lamb carcasses with prostate mimicking pelvic tissue, to demonstrate capability of spatio-temporal temperature control and to assess potential risks and side effects. Our optimization approach yielded a therapeutic ultrasound transducer consisting of 192 elements of variable shape and surface, pseudo randomly distributed on 6 columns, using a frequency of 700 kHz. Radius of curvature was 140 mm and active water circulation was included for cooling. The measured focusing capabilities covered a volume of 24 × 50 × 60 mm3. Acoustic coupling of excellent quality was achieved. No interference was detected between sonication and MR acquisitions. On ex vivo experiments the target temperature elevation of 5 °C was reached after 5 min and maintained during another 15 min with the predictive temperature controller showing 0.2 °C accuracy. No significant temperature rise was observed on skin and bonny structures. Reported results represent a promising step toward the implementation of transperineal ultrasound hyperthermia in a pilot study of reirradiation in prostate cancer patients.
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Pirrone G, Matrone F, Chiovati P, Manente S, Drigo A, Donofrio A, Cappelletto C, Borsatti E, Dassie A, Bortolus R, Avanzo M. Predicting Local Failure after Partial Prostate Re-Irradiation Using a Dosiomic-Based Machine Learning Model. J Pers Med 2022; 12:1491. [PMID: 36143276 PMCID: PMC9505150 DOI: 10.3390/jpm12091491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/22/2022] Open
Abstract
The aim of this study is to predict local failure after partial prostate re-irradiation for the treatment of isolated locally recurrent prostate cancer by using a machine learning classifier based on radiomic features from pre-treatment computed tomography (CT), positron-emission tomography (PET) and biological effective dose distribution (BED) of the radiotherapy plan. The analysis was conducted on a monocentric dataset of 43 patients with evidence of isolated intraprostatic recurrence of prostate cancer after primary external beam radiotherapy. All patients received partial prostate re-irradiation delivered by volumetric modulated arc therapy. The gross tumor volume (GTV) of each patient was manually contoured from planning CT, choline-PET and dose maps. An ensemble machine learning pipeline including unbalanced data correction and feature selection was trained using the radiomic and dosiomic features as input for predicting occurrence of local failure. The model performance was assessed using sensitivity, specificity, accuracy and area under receiver operating characteristic curves of the score function in 10-fold cross validation repeated 100 times. Local failure was observed in 13 patients (30%), with a median time to recurrence of 36.7 months (range = 6.1-102.4 months). A four variables ensemble machine learning model resulted in accuracy of 0.62 and AUC 0.65. According to our results, a dosiomic machine learning classifier can predict local failure after partial prostate re-irradiation.
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Affiliation(s)
- Giovanni Pirrone
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Fabio Matrone
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Paola Chiovati
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Stefania Manente
- Nuclear Medicine Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Annalisa Drigo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Alessandra Donofrio
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Cristina Cappelletto
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Eugenio Borsatti
- Nuclear Medicine Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Andrea Dassie
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Roberto Bortolus
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
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Di Franco R, Borzillo V, Scipilliti E, Ametrano G, Serra M, Arrichiello C, Savino F, De Martino F, D’Alesio V, Cammarota F, Crispo A, Pignata S, Rossetti S, Quarto G, Muto P. Reirradiation of Locally Recurrent Prostate Cancer with Cyberknife® System or Volumetric Modulated Arc Therapy (VMAT) and IGRT-Clarity®: Outcomes, Toxicities and Dosimetric Evaluation. Cancers (Basel) 2022; 14:cancers14133187. [PMID: 35804958 PMCID: PMC9264827 DOI: 10.3390/cancers14133187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
The management of prostate cancer recurrence following external beam radiotherapy is not defined yet. Stereotaxic body reirradiation therapy showed encouraging results for local and biochemical control. From April 2017 to December 2020, 29 patients with prostate cancer recurrence were collected, joining the retrospective studies CyPro (prot. 46/19 OSS) and CLARO (Prot. 19/20 OSS) trials. Patients received Cyberknife® treatment (17 pts) or alternatively VMAT (Volumetric Modulated Arc Technique) therapy by IGRT (Image-Guided Radiation Therapy)/Clarity® (12 pts). By comparing the reirradiation of two groups, urinary (GU), rectal (GI) toxicities, and biochemical control were investigated. Further, the two techniques were dosimetrically compared by rival plans. The VMAT-IGRT Clarity® treatments were replanned with an optimized template developed for prostate VMAT-SBRT in FFF mode keeping the same dose and fractionation scheduled for Cyberknife Group (30 Gy in 5 fx, at 80% isodose). In the CK group, 23% of patients experienced grade 2 acute GU, while 6% grade 2 acute GI. In the VMAT-Clarity® group, acute GU toxicity was recorded in 17%, while for 8% grade 2 late toxicity was recorded. The dosimetric analysis shows that the VMAT-FFF allows to deliver a biological equivalent dose to CK, with the advantage of reducing the likelihood of toxicities arising.
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Affiliation(s)
- Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (V.B.); (E.S.); (G.A.); (M.S.); (C.A.); (V.D.); (P.M.)
- Correspondence: ; Tel.: +39-08159031764; Fax: +39-0815903809
| | - Valentina Borzillo
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (V.B.); (E.S.); (G.A.); (M.S.); (C.A.); (V.D.); (P.M.)
| | - Esmeralda Scipilliti
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (V.B.); (E.S.); (G.A.); (M.S.); (C.A.); (V.D.); (P.M.)
| | - Gianluca Ametrano
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (V.B.); (E.S.); (G.A.); (M.S.); (C.A.); (V.D.); (P.M.)
| | - Marcello Serra
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (V.B.); (E.S.); (G.A.); (M.S.); (C.A.); (V.D.); (P.M.)
| | - Cecilia Arrichiello
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (V.B.); (E.S.); (G.A.); (M.S.); (C.A.); (V.D.); (P.M.)
| | | | - Fortuna De Martino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy;
| | - Valentina D’Alesio
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (V.B.); (E.S.); (G.A.); (M.S.); (C.A.); (V.D.); (P.M.)
| | | | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (S.R.)
| | - Sandro Pignata
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy;
| | - Sabrina Rossetti
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (S.R.)
| | - Giuseppe Quarto
- Department of Uro-Gynecological, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy;
| | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (V.B.); (E.S.); (G.A.); (M.S.); (C.A.); (V.D.); (P.M.)
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5
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Augugliaro M, Marvaso G, Cambria R, Pepa M, Bagnardi V, Frassoni S, Pansini F, Patricia Rojas D, Colombo F, Iuliana Fodor C, Musi G, Petralia G, De Cobelli O, Cattani F, Orecchia R, Zerini D, Jereczek-Fossa BA. Finding safe dose-volume constraints for re-irradiation with SBRT of patients with prostate cancer relapse: The IEO experience. Phys Med 2021; 92:62-68. [PMID: 34871888 DOI: 10.1016/j.ejmp.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/14/2021] [Accepted: 11/20/2021] [Indexed: 12/16/2022] Open
Abstract
AIM The primary aim of this study is to provide preliminary indications for safe constraints of rectum and bladder in patients re-irradiated with stereotactic body RT (SBRT). METHODS Data from patients treated for prostate cancer (PCa) and intraprostatic relapse, from 1998 to 2016, were retrospectively collected. First RT course was delivered with 3D conformal RT techniques, SBRT or volumetric modulated arc therapy (VMAT). All patients underwent re-irradiation with SBRT with heavy hypofractionated schedules. Cumulative dose-volume values to organs at risk (OARs) were computed and possible correlation with developed toxicities was investigated. RESULTS Twenty-six patients were included. Median age at re-irradiation was 75 years, mean interval between the two RT courses was 5.6 years and the median follow-up was 47.7 months (13.4-114.3 months). After re-irradiation, acute and late G ≥ 2 GU toxicity events were reported in 3 (12%) and 10 (38%) patients, respectively, while late G ≥ 2 GI events were reported in 4 (15%) patients. No acute G ≥ 2 GI side effects were registered. Patients receiving an equivalent uniform dose of the two RT treatments < 131 Gy appeared to be at higher risk of progression (4-yr b-PFS: 19% vs 33%, p = 0.145). Cumulative re-irradiation constraints that appear to be safe are D30% < 57.9 Gy for bladder and D30% < 66.0 Gy, D60% < 38.0 Gy and V122.1 Gy < 5% for rectum. CONCLUSION Preliminary re-irradiation constraints for bladder and rectum have been reported. Our preliminary investigation may serve to clear some grey areas of PCa re-irradiation.
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Affiliation(s)
- Matteo Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy.
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Floriana Pansini
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Damaris Patricia Rojas
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Francesca Colombo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Cristiana Iuliana Fodor
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; Division of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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6
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Jereczek-Fossa BA, Marvaso G, Zaffaroni M, Gugliandolo SG, Zerini D, Corso F, Gandini S, Alongi F, Bossi A, Cornford P, De Bari B, Fonteyne V, Hoskin P, Pieters BR, Tree AC, Arcangeli S, Fuller DB, Franzese C, Hannoun-Levi JM, Janoray G, Kerkmeijer L, Kwok Y, Livi L, Loi M, Miralbell R, Pasquier D, Pinkawa M, Scher N, Scorsetti M, Shelan M, Toledano A, van As N, Vavassori A, Zilli T, Pepa M, Ost P. Salvage stereotactic body radiotherapy (SBRT) for intraprostatic relapse after prostate cancer radiotherapy: An ESTRO ACROP Delphi consensus. Cancer Treat Rev 2021; 98:102206. [PMID: 33965893 DOI: 10.1016/j.ctrv.2021.102206] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Between 30% and 47% of patients treated with definitive radiotherapy (RT) for prostate cancer are at risk of intraprostatic recurrence during follow-up. Re-irradiation with stereotactic body RT (SBRT) is emerging as a feasible and safe therapeutic option. However, no consensus or guidelines exist on this topic. The purpose of this ESTRO ACROP project is to investigate expert opinion on salvage SBRT for intraprostatic relapse after RT. MATERIALS AND METHODS A 40-item questionnaire on salvage SBRT was prepared by an internal committee and reviewed by a panel of leading radiation oncologists plus a urologist expert in prostate cancer. Following the procedure of a Delphi consensus, 3 rounds of questionnaires were sent to selected experts on prostate re-irradiation. RESULTS Among the 33 contacted experts, 18 (54.5%) agreed to participate. At the end of the final round, participants were able to find consensus on 14 out of 40 questions (35% overall) and major agreement on 13 questions (32.5% overall). Specifically, the consensus was reached regarding some selection criteria (no age limit, ECOG 0-1, satisfactory urinary flow), diagnostic procedures (exclusion of metastatic disease, SBRT target defined on the MRI) and therapeutic approach (no need for concomitant ADT, consideration of the first RT dose, validity of Phoenix criteria for salvage SBRT failure). CONCLUSION While awaiting the results of ongoing studies, our ESTRO ACROP Delphi consensus may serve as a practical guidance for salvage SBRT. Future research should address the existing disagreements on this promising approach.
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Affiliation(s)
- Barbara A Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Simone Giovanni Gugliandolo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy; Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Dario Zerini
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Corso
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Centre for Analysis Decisions and Society (CADS), Human Technopole, Department of Mathematics (DMAT) - MOX Laboratory, Politecnico di Milano, Milan, Italy
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo Alongi
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy; University of Brescia, Brescia, Italy
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - Philip Cornford
- Liverpool University Hospitals Foundation NHS Trust, Liverpool, UK
| | - Berardino De Bari
- Radiation Oncology, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland; University of Lausanne (UniL), Lausanne, Switzerland
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Stefano Arcangeli
- Department of Radiation Oncology, S. Gerardo Hospital, University of Milan Bicocca, Milan, Italy
| | - Donald B Fuller
- Department of Radiation Oncology, Genesis Health Care Partners, Inc, San Diego, CA, USA
| | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice, France
| | - Guillaume Janoray
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium; University François-Rabelais, Tours, France
| | | | - Young Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Mauro Loi
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | | | - David Pasquier
- Academic Department of Radiation Oncology, Centre O. Lambret, Lille, France; CRIStAL UMR 9189, Lille University, Lille, France
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Nathaliel Scher
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France; Rafael Institute Center for Predictive Medicine, Levallois-Perret, France
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alain Toledano
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France; Rafael Institute Center for Predictive Medicine, Levallois-Perret, France
| | - Nicholas van As
- Department of Clinical Oncology, St Thomas' Hospital, London, UK
| | - Andrea Vavassori
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Matteo Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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7
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Mazzola R, Francolini G, Triggiani L, Napoli G, Cuccia F, Nicosia L, Livi L, Magrini SM, Salgarello M, Alongi F. Metastasis-directed Therapy (SBRT) Guided by PET-CT 18F-CHOLINE Versus PET-CT 68Ga-PSMA in Castration-sensitive Oligorecurrent Prostate Cancer: A Comparative Analysis of Effectiveness. Clin Genitourin Cancer 2021; 19:230-236. [DOI: 10.1016/j.clgc.2020.08.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 12/19/2022]
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Outcomes and toxicities of re-irradiation for prostate cancer: A systematic review on behalf of the Re-Irradiation Working Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Cancer Treat Rev 2021; 95:102176. [PMID: 33743409 DOI: 10.1016/j.ctrv.2021.102176] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022]
Abstract
AIMS The best therapeutic approach for local relapses of previously irradiated prostate cancer (PC) is still not defined. Re-irradiation (Re-I) could offer a chance of cure for highly selected patients, although high quality evidences are lacking. The aim of our study is to provide a literature review on efficacy and safety of Re-I. METHODS Only studies where Re-I field overlaps with previous radiotherapy were considered. To determine 2 and 4 years overall mortality (OM), 2 and 4 years biochemical failure (BF) and pooled acute and late G ≥ 3 toxicities rate, a meta-analysis over single arm study was performed. RESULTS Thirty-eight studies with 1194 patients were included. Median follow-up from Re-I was 30 months (10-94 months). Brachytherapy (BRT) was the most used Re-I technique (27 studies), followed by Stereotactic Body Radiotherapy (SBRT) (9) and External Beam Radiation Therapy (EBRT) (2). Re-I prescription doses ranged from 19 Gy in single HDR fraction to 145 Gy (interstitial BRT). The pooled 2 and 4 years OM rates were 2.1% (95%CI:1.1-3.7%, P < 0.001) and 12.5% (95%CI:8.1-19.5%; P < 0.001). The pooled 2 years BF rate was 24% (95% CI: 19.1-30.2%, P < 0.001). The pooled 4 years BF was 35.6% (95% CI: 28.7-44.3%, P < 0.001). The pooled result of G ≥ 3 acute toxicity was 1.4% (95%CI: 0.7-3%, P < 0.001). One hundred and three G ≥ 3 late adverse events were reported, with a pooled result of G ≥ 3 late toxicity of 8.7% (95%CI: 5.8-13%, P < 0.001). CONCLUSIONS Re-I of local failures from PC showed promising OM and biochemical control rates with a safe toxicity profile.
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Cuccia F, Mazzola R, Nicosia L, Giaj-Levra N, Figlia V, Ricchetti F, Rigo M, Vitale C, Corradini S, Alongi F. Prostate re-irradiation: current concerns and future perspectives. Expert Rev Anticancer Ther 2020; 20:947-956. [PMID: 32909471 DOI: 10.1080/14737140.2020.1822742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION To date, the optimal management of locally relapsed prostate cancer patients after an initial course of radiotherapy remains a matter of debate. In recent years, local approaches have been proposed as a therapeutic option, which may potentially delay the initiation of hormone therapy. In the case of external beam radiotherapy (EBRT), re-irradiation has been supported by growing evidence in the literature, mostly represented by extreme hypofractionated schedules delivered with stereotactic body radiotherapy (SBRT). AREAS COVERED We performed a systematic review of the literature using the PICO methodology to explore the available evidence regarding the use of EBRT in the setting of locally relapsed prostate cancer, both in terms of safety, tolerability and preliminary clinical outcomes. EXPERT OPINION Current literature data report the use of EBRT and particularly of SBRT for the safe and feasible re-treatment of locally recurrent prostate cancer after an initial treatment course of radiotherapy. When extreme hypofractionation is adopted, only occasional grade ≥3 late adverse events are reported. Despite the current lack of high-level evidence and the short follow-up, preliminary clinical outcomes are promising and allow clinicians to hypothesize further prospective studies to evaluate SBRT as an alternative to the early initiation of androgen-deprivation therapy.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Claudio Vitale
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, University of Munich , Munich, Germany
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar , Verona, Italy.,University of Brescia , Brescia, Italy
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Pons-Llanas O, Burgos-Burgos J, Roldan-Ortega S, Conde-Moreno A, Celada-Alvarez F, Ruiz-Martinez JC, Lliso-Valverde F, Tormo-Micó A, Perez-Calatayud J, López-Torrecilla J. Salvage I-125 brachytherapy for locally-recurrent prostate cancer after radiotherapy. Rep Pract Oncol Radiother 2020; 25:754-759. [PMID: 32684865 DOI: 10.1016/j.rpor.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/15/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose Retrospective, single-institution analysis of clinical outcomes and treatment-related toxicity in patients treated with salvage I-125 low-dose rate (LDR) brachytherapy (BT) for locally-recurrent prostate cancer after radiotherapy. Materials and methods Between 2008 and 2018, 30 patients with biopsy-confirmed prostate cancer recurrence underwent salvage treatment with I-125 LDR-BT. Of these 30 patients, 14 were previously treated with primary external beam radiotherapy (EBRT; median dose, 73 Gy) and 16 with primary I-125 LDR-BT (145 Gy and 160 Gy in 14 and 2 cases, respectively). At seed implantation, the mean age was 75.8 years, with a median Gleason score of 7 and pre-salvage PSA of <10 ng/mL. Six patients received androgen deprivation therapy for six months after relapse diagnosis. The prescribed salvage I-125 BT dose to the gland was 120-130 Gy, with dose restrictions of Dmax <135% (urethra) and <100% (rectum). Toxicity was evaluated according to the CTCAE scale (v4.0). Results At a median follow-up of 45 months, the biochemical recurrence-free survival rates at 1, 3 and 5 years were 86.7%, 56.7% and 53.3%, respectively. Overall survival at 5 years was 87%. On the multivariate analysis, two variables were significant predictors of recurrence: PSA at relapse and nadir PSA post-salvage. Grade 3 genitourinary toxicity was observed in 5 patients (radiation-induced cystitis in 3 cases and urethral stenosis in 2) and G3 gastrointestinal toxicity in 3 patients (rectal bleeding). Conclusion Salvage therapy with I-125 brachytherapy is a safe and effective treatment option for locally-recurrent prostate cancer in previously-irradiated patients. High pre-salvage PSA and post-salvage nadir PSA values were significantly associated with a worse disease control after salvage I-125 LDR-BT. In well-selected patients, I-125 LDR-BT is comparable to other salvage therapies in terms of disease control and toxicity. However, more research is needed to determine the optimal management of locally-recurrent prostate cancer.
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Affiliation(s)
- O Pons-Llanas
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia Spain
| | - J Burgos-Burgos
- Radiotherapy Department, Hospital, Las Palmas de Gran Canaria, Spain
| | - S Roldan-Ortega
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia Spain
| | - A Conde-Moreno
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia Spain
| | - F Celada-Alvarez
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia Spain
| | - J C Ruiz-Martinez
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia Spain
| | - F Lliso-Valverde
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia Spain
| | - A Tormo-Micó
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia Spain
| | - J Perez-Calatayud
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia Spain
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Zerini D, Jereczek-Fossa BA, Ciabattoni A, Mirri A, Bertoni F, Fersino S, D'Agostino G, Lohr F, Mortellaro G, Triggiani L, Marvaso G, Pepa M, Cuccia F, Alongi F. PROLAPSE: survey about local prostate cancer relapse salvage treatment with external beam re-irradiation: results of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). J Cancer Res Clin Oncol 2020; 146:2311-2317. [PMID: 32583236 DOI: 10.1007/s00432-020-03297-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/20/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE We herein present the results of the first Italian Association of Radiotherapy and Clinical Oncology (AIRO) survey regarding salvage external beam re-irradiation of local prostate cancer relapse named PROLAPSE. METHODS A questionnaire with 12 items was administered to the 775 Italian radiation oncologist members of the AIRO. RESULTS One hundred of the members completed the survey. The survey highlighted that 59% of the participants are currently performing prostate re-EBRT, while nearly two-thirds (65%) affirmed that they are taking into consideration the procedure in case of intraprostatic relapse. Regarding the clinical target volume (CTV), only a minority (16%) declared to always prefer the partial prostate re-irradiation, while a consistent portion (nearly two-thirds) relied on clinical considerations of the choice towards partial or whole gland irradiation. The main techniques used for re-irradiation resulted to be intensity-modulated RT (IMRT)/volumetric modulated arc therapy (VMAT) and SBRT, having received approximately 40% of responses each. Regarding the criteria for patients' selection, more than 75% of responders agreed on the use of positron emission tomography (PET)/computed tomography (CT)-choline to exclude distant metastases and of multiparametric magnetic resonance imaging (mp-MRI) to detect intraprostatic recurrence. A sufficient timeframe (> 3 years) between primary RT and reirradiation was indicated by more than half of participants as an important driver in decision-making, while histological confirmation of the relapse was considered not essential by more than two-thirds. For the use of concomitant androgen deprivation therapy (ADT), most AIRO members (79%) agreed that the prescription should be based on a case-by-case analysis. Extreme hypofractionation (> 5 Gy/fraction) was preferred by the majority (52%) of the AIRO members. In most centers (more than 74%), the planning dose-volume constraints were generally extrapolated from the published data. In half of the cases, the interviewed responders affirmed that no major gastrointestinal (GI) and genitourinary (GU) toxicities were registered in the follow-up of their re-EBRT patients. Bladder complications represented the most commonly observed form of toxicity, with an incidence of 67%. CONCLUSION This first AIRO survey about salvage prostate re-EBRT provides an interesting snapshot and suggests increasing interest in re-EBRT patients in Italy. Consensus about some aspects of patients' selection, the necessity of biopsy, fractionation, and highly selective techniques seems feasible, but other key points such as irradiated volume, dosimetry parameters, and hormonal treatment association need to be clarified.
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Affiliation(s)
- Dario Zerini
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Alessandra Mirri
- Radiotherapy Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Filippo Bertoni
- AIRO Italian Association of Radiotherapy and Clinical Oncology, Rome, Italy
| | - Sergio Fersino
- Radiotherapy Division, Santa Chiara Hospital, Trento, Italy
| | - Giuseppe D'Agostino
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital, IRCSS, Rozzano, Milan, Italy
| | - Frank Lohr
- Department of Oncology, Radiotherapy Unit, Modena, Italy
| | | | - Luca Triggiani
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, Brescia University, Brescia, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Matteo Pepa
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Cuccia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
- Radiation Oncology Department, University of Brescia, Brescia, Italy
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12
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Khoo CC, Miah S, Connor MJ, Tam J, Winkler M, Ahmed HU, Shah TT. A systematic review of salvage focal therapies for localised non-metastatic radiorecurrent prostate cancer. Transl Androl Urol 2020; 9:1535-1545. [PMID: 32676441 PMCID: PMC7354313 DOI: 10.21037/tau.2019.08.21] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022] Open
Abstract
Although radiotherapy to the prostate for cancer is effective, recurrence occurs in 10-15% within 5 years. Traditional salvage treatments for men with radiorecurrent prostate cancer comprise of watchful waiting (WW) with or without androgen deprivation therapy (ADT) or radical prostatectomy (RP). Neither strategy provides ideal therapeutic ratios. Salvage focal ablation is an emerging option. We performed a systematic review of the Medline and Embase databases for studies reporting outcomes of focal salvage brachytherapy (sBT), cryotherapy (sCT) or high-intensity focused ultrasound (sHIFU) for radiorecurrent prostate cancer (conception to April 2019). Results were screened for inclusion against predetermined eligibility criteria. Certain data were extracted, including rates of biochemical disease-free survival (BDFS), metastasis, conversion to second-line therapies and adverse events. Of a total 134 articles returned from the search, 15 studies (14 case series and 1 comparative study) reported outcomes after focal sBT [5], sCT [7] and sHIFU [3]. Cohort size varied depending on intervention, with eligible studies of sBT being small case series. Median follow-up ranged from 10 to 56 months. Although pre-salvage demographics were similar [median age range, 61-75 years; prostate-specific antigen (PSA) range, 2.8-5.5 ng/mL], there was heterogeneity in patient selection, individual treatment protocols and outcome reporting. At 3 years, BDFS ranged from 61% to 71.4% after sBT, 48.1-72.4% after sCT and 48% after sHIFU. Only studies of sCT reported 5-year BDFS, which ranged from 46.5% to 54.4%. Rates of metastasis were low after all salvage modalities, as were conversion to second-line therapies (although this was poorly reported). Grade 3 adverse events were rare. This systematic review indicates that salvage focal ablation of radiorecurrent prostate cancer provides acceptable oncological outcomes and is well tolerated. Unfortunately, there is heterogeneity in the study design of existing evidence. Level 1 research comparing salvage focal therapies to existing whole-gland strategies is needed to further establish the role of these promising treatments.
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Affiliation(s)
- Christopher C. Khoo
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Saiful Miah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Martin J. Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Joseph Tam
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U. Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T. Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
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13
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Linac-based SBRT as a feasible salvage option for local recurrences in previously irradiated prostate cancer. Strahlenther Onkol 2020; 196:628-636. [DOI: 10.1007/s00066-020-01628-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/25/2020] [Indexed: 12/24/2022]
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14
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Niziers V, Boissier R, Borchiellini D, Deville JL, Khoury C, Durand M, Toledano H, Albert T, Branger N, Bandelier Q, Ouvrier MJ, Gabriel S, Hoch B, Gross E, Walz J, Brenot-Rossi I, Pignot G. “Real-world” evaluation of 18F-Choline PET/CT practices in prostate cancer patients and impact on changes in therapeutic strategy. Urol Oncol 2020; 38:2.e1-2.e9. [DOI: 10.1016/j.urolonc.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 12/15/2022]
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15
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Scher N, Bauduceau O, Bollet M, Lamallem H, Charas T, Garaud P, Foster D, Fawzi M, Labidi M, Toledano A. Stereotactic prostate focal reirradiation therapy for local recurrence: preliminary results of Hartmann Oncology Radiotherapy Group. BJR Open 2019; 1:20180027. [PMID: 33178921 PMCID: PMC7592466 DOI: 10.1259/bjro.20180027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/05/2022] Open
Abstract
Objective Our objective was to report our experience and to evaluate the feasibility and toxicity of focal salvage stereotactic body radiation therapy (SBRT) in patients with post-radiation local recurrence of prostate cancer. Methods We retrospectively reviewed medical records of patients treated with Cyberknife ® between October 2014 and April 2017 at our institution for a focal reirradiation delivered to the prostate/prostatic bed for local recurrence after radical or adjuvant radiotherapy. All patients underwent prostate biopsies at recurrence at the time of fiducial markers placement, had choline PET/CT and pelvic MRI. The treatment consisted in 36 Gy in six fractions delivered every other day. Post reirradiation toxicities were assessed according to the CTCAE v4 (Common Terminology Criteria for Adverse Events). Results 42 patients were treated with followed with a median follow-up of 21 months (range 3 - 31). 34 patients had biopsy proven recurrence. The initial treatment was radical prostatectomy and radiation therapy for 9 patients and radiation therapy alone for 33 patients. 23 patients from the group of prostate reirradiation had placement of rectal spacers. No Grade 4 or 5 toxicity were observed. 27 acute urinary events were recorded: 18 patients experienced Grade 1, 9 patients experienced Grade 2 toxicity and 1 patient experienced Grade 3 urinary toxicity, namely cystitis and/or dysuria. No Grade 2 or more digestive toxicity was observed. Rectal doses were significantly lower with rectal spacers. Conclusion Salvage focal Cyberknife ® seems feasible and show promising results. Advances in knowledge SBRT for local prostate cancer recurrence after initial radiotherapy is well tolerated with short follow-up.
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Affiliation(s)
| | | | | | | | - Tomer Charas
- Department of Radiation Oncology, MSKCC, New York, USA
| | - Pascal Garaud
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France
| | - Denis Foster
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France
| | - Maher Fawzi
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France
| | - Mona Labidi
- Hartmann Radiotherapy Institute, Hartmann Oncology Radiotherapy Group, Levallois-Perret, France
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Jereczek-Fossa BA, Rojas DP, Zerini D, Fodor C, Viola A, Fanetti G, Volpe S, Luraschi R, Bazani A, Rondi E, Cattani F, Vavassori A, Garibaldi C, Alessi S, Pricolo P, Petralia G, Cozzi G, De Cobelli O, Musi G, Orecchia R, Marvaso G, Ciardo D. Reirradiation for isolated local recurrence of prostate cancer: Mono-institutional series of 64 patients treated with salvage stereotactic body radiotherapy (SBRT). Br J Radiol 2019; 92:20180494. [PMID: 30379566 PMCID: PMC6404844 DOI: 10.1259/bjr.20180494] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/22/2018] [Accepted: 10/13/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE: To evaluate high-precision external beam reirradiation (re-EBRT) for local relapse of prostate cancer (PCa) after radiotherapy. METHODS: This retrospective study included patients with biochemical failure and evidence of isolated local recurrence of PCa after radical/salvage EBRT or brachytherapy that received salvage stereotactic body radiation therapy (SBRT, re-EBRT). Biopsy was not mandatory if all diagnostic elements were univocal (prostate specific antigen evolution, choline-positron emission tomography or magnetic resonance imaging). Salvage SBRT (re-EBRT) was delivered with image-guided radiation therapy (RapidArc®, VERO® and CyberKnife®). RESULTS: Data of 64 patients were included, median age at salvage SBRT was 73.2 years, median pre-salvage SBRT prostate specific antigen was 3.89 ng ml-1 . Median total dose was 30 Gy in five fractions, biologically effective dose (BED) of 150 Gy. One acute G3 genitourinary event and one late G3 genitourinary event were observed. No G ≥ 3 bowel toxicity was registered. At the median follow-up of 26.1 months, tumor progression was observed in 41 patients (64%). 18 patients (28%) experienced local relapse. 2-year local control, biochemical and clinical relapse free survival rates were 75, 40 and 53%, respectively. With BED ≥130 Gy 1-year biochemical and clinical progression-free survival rate were 85 and 90%, respectively. CONCLUSIONS: Salvage SBRT (re-EBRT) for isolated local PCa recurrence is a safe, feasible and noninvasive salvage treatment. Further investigation is warranted to define the optimal patient selection, dose and volume parameters. ADVANCES IN KNOWLEDGE: Salvage SBRT reirradiation for the locally recurrent PCa offer a satisfactory tumor control and excellent toxicity profile, if BED ≥130 Gy is administered.
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Affiliation(s)
| | | | - Dario Zerini
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Cristiana Fodor
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | | | - Rosa Luraschi
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessia Bazani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Vavassori
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Cristina Garibaldi
- Radiation Research Unit, European Institute of Oncology IRCCS, Milano, Italy
| | - Sarah Alessi
- Division of Radiology, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Division of Radiology, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Gennaro Musi
- Division of Urology, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy
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17
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Lieng H, Hayden AJ, Christie DRH, Davis BJ, Eade TN, Emmett L, Holt T, Hruby G, Pryor D, Shakespeare TP, Sidhom M, Skala M, Wiltshire K, Yaxley J, Kneebone A. Radiotherapy for recurrent prostate cancer: 2018 Recommendations of the Australian and New Zealand Radiation Oncology Genito-Urinary group. Radiother Oncol 2018; 129:377-386. [PMID: 30037499 DOI: 10.1016/j.radonc.2018.06.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022]
Abstract
The management of patients with biochemical, local, nodal, or oligometastatic relapsed prostate cancer has become more challenging and controversial. Novel imaging modalities designed to detect recurrence are increasingly used, particularly PSMA-PET scans in Australia, New Zealand and some European countries. Imaging techniques such as MRI and PET scans using other prostate cancer-specific tracers are also being utilised across the world. The optimal timing for commencing salvage treatment, and the role of local and/or systemic therapies remains controversial. Through surveys of the membership, the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group (FROGG) identified wide variation in the management of recurrent prostate cancer. Following a workshop conducted in April 2017, the FROGG management committee reviewed the literature and developed a set of recommendations based on available evidence and expert opinion, for the appropriate investigation and management of recurrent prostate cancer. These recommendations cover the role and timing of post-prostatectomy radiotherapy, the management of regional nodal metastases and oligometastases, as well as the management of local prostate recurrence after definitive radiotherapy.
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Affiliation(s)
- Hester Lieng
- Central Coast Cancer Centre, Gosford Hospital, Australia.
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Australia
| | - David R H Christie
- Genesis Cancer Care, Australia; Department of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas N Eade
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - Louise Emmett
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia
| | - Tanya Holt
- University of Queensland, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - George Hruby
- Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Thomas P Shakespeare
- North Coast Cancer Institute, Coffs Harbour, Australia; University of New South Wales Rural Clinical School, Australia
| | - Mark Sidhom
- Liverpool Hospital Cancer Therapy Centre, Sydney, Australia; University of New South Wales, Australia
| | | | | | - John Yaxley
- University of Queensland, Australia; Royal Brisbane and Women's Hospital, Australia; Wesley Urology Clinic, Brisbane, Australia
| | - Andrew Kneebone
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
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18
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Does Specialty Bias Trump Evidence in the Management of High-risk Prostate Cancer? Am J Clin Oncol 2018; 41:549-557. [DOI: 10.1097/coc.0000000000000323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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De Bari B, Mazzola R, Aiello D, Fersino S, Gregucci F, Alongi P, Nicodemo M, Cavalleri S, Salgarello M, Alongi F. Could 68-Ga PSMA PET/CT become a new tool in the decision-making strategy of prostate cancer patients with biochemical recurrence of PSA after radical prostatectomy? A preliminary, monocentric series. Radiol Med 2018; 123:719-725. [DOI: 10.1007/s11547-018-0890-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/09/2018] [Indexed: 12/17/2022]
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20
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Loi M, Di Cataldo V, Simontacchi G, Detti B, Bonomo P, Masi L, Desideri I, Greto D, Francolini G, Carfora V, Pezzulla D, Perna M, Carta G, Livi L. Robotic Stereotactic Retreatment for Biochemical Control in Previously Irradiated Patients Affected by Recurrent Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:93-100. [DOI: 10.1016/j.clon.2017.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/28/2017] [Accepted: 11/06/2017] [Indexed: 12/31/2022]
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21
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Miki K, Kimura S, Ohnuma H, Sakanaka K, Sasaki H, Kimura T, Takahashi H, Egawa S. [SALVAGE CRYOABLATION TARGETING RECURRENT LESIONS AFTER DEFINITIVE RADIOTHERAPY FOR PROSTATE CANCER: IMPACT OF POST CRYOABLATION CHANGE IN URINARY AND SEXUAL FUNCTION]. Nihon Hinyokika Gakkai Zasshi 2018; 109:184-193. [PMID: 31631081 DOI: 10.5980/jpnjurol.109.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Purpose) To describe our initial experience in salvage cryoablation targeting recurrent lesions after definitive irradiation for prostate cancer. (Methods) Eligible patients for this treatment were those who developed biochemical failure after definitive radiotherapy for localized prostate cancer, but without distant metastasis, and with solid lesions identifiable on multiparametric magnetic resonance imaging (mpMRI). Histological proof of recurrence with mapping biopsy covering corresponding sites was obtained. Two to four cryoprobes were inserted transperineally into the prostate under general anesthesia with extensive lithotomy position. The rapid expansion of argon gas cryogen through a small opening within the cryoprobe cools itself to make an ice ball and the quick exchange to helium gas induces an active thawing phase. Entire procedure is monitored and guided with the use of transrectal ultrasonography. Postoperative follow-up included patient interview, digital rectal examination, prostate specific antigen (PSA) testing and quality of life (QOL) monitoring using IPSS and IIEF-5 at 1, 3, 6 and 12 months postoperatively. Changes of mpMRI findings with time, particularly at one month, were used to judge immediate treatment impact. (Results) Five patients underwent salvage cryoablation between October 2015 and September 2016. No grade 3/4 complications such as rectal fistula or urethral stenosis were experienced. Mean and maximal percent decline of PSA from baseline levels at 1, 3, 6 and 12 months following cryoablation were 72.2 and 94.7%, 79.4% and 93.9%, 78.2% and 92.1%, 79.6% and 90.9%, respectively. Posttreatment IPSS showed temporary worsening with average changes in score of 1.8, 1.5, 1.6, and 1.0 times over baseline levels, respectively. IPSS score returned to the baseline in one at six months and two at 12 months. Two of 5 patients were sexually active prior to therapy and thus evaluable. Both showed significant decline in IIEF score by 95% at 12 months. No patients showed any signs of recurrence. mpMRI at one month following cryoablation confirmed complete disappearance of visible lesions in all cases. (Conclusions) Salvage cryoablation for recurrent lesions of prostate cancer after definitive radiotherapy is feasible with minimal morbidity. Both oncological outcome and adverse events should be monitored carefully with longer follow up.
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Affiliation(s)
- Kenta Miki
- Department of Urology, Jikei University School of Medicine
| | - Shoji Kimura
- Department of Urology, Jikei University School of Medicine
| | - Hajime Ohnuma
- Department of Urology, Jikei University School of Medicine
| | - Keigo Sakanaka
- Department of Urology, Jikei University School of Medicine
| | - Hiroshi Sasaki
- Department of Urology, Jikei University School of Medicine
| | | | | | - Shin Egawa
- Department of Urology, Jikei University School of Medicine
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22
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Maenhout M, Peters M, van Vulpen M, Moerland MA, Meijer RP, van den Bosch MAAJ, Nguyen PL, Frank SJ, van der Voort van Zyp JRN. Focal MRI-Guided Salvage High-Dose-Rate Brachytherapy in Patients With Radiorecurrent Prostate Cancer. Technol Cancer Res Treat 2017; 16:1194-1201. [PMID: 29333958 PMCID: PMC5762090 DOI: 10.1177/1533034617741797] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Whole-gland salvage treatment of radiorecurrent prostate cancer has a high rate of severe toxicity. The standard of care in case of a biochemical recurrence is androgen deprivation treatment, which is associated with morbidity and negative effects on quality of life. A salvage treatment with acceptable toxicity might postpone the start of androgen deprivation treatment, might have a positive influence on the patients’ quality of life, and might even be curative. Here, toxicity and biochemical outcome are described after magnetic resonance imaging–guided focal salvage high-dose-rate brachytherapy in patients with radiorecurrent prostate cancer. Materials and Methods: Seventeen patients with pathologically proven locally recurrent prostate cancer were treated with focal high-dose-rate brachytherapy in a single 19-Gy fraction using magnetic resonance imaging for treatment guidance. Primary radiotherapy consisted of external beam radiotherapy or low-dose-rate brachytherapy. Tumors were delineated with Ga-68–prostate-specific membrane antigen or F18-choline positron emission tomography in combination with multiparametric magnetic resonance imaging. All patients had a prostate-specific antigen level of less than 10 ng/mL at the time of recurrence and a prostate-specific antigen doubling time of ≥12 months. Toxicity was measured by using the Common Terminology Criteria for Adverse Events version 4. Results: Eight of 17 patients had follow-up interval of at least 1 year. At a median follow-up interval of 10 months (range 3-40 months), 1 patient experienced a biochemical recurrence according to the Phoenix criteria, and prostate-specific membrane antigen testing revealed that this was due to a distant nodal metastasis. One patient had a grade 3 urethral stricture at 2 years after treatment. Conclusion: Focal salvage high-dose-rate brachytherapy in patients with radiorecurrent prostate cancer showed grade 3 toxicity in 1 of 17 patients and a distant nodal metastasis in another patient. Whether this treatment option leads to cure in a subset of patients or whether it can successfully postpone androgen deprivation treatment needs further investigation.
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Affiliation(s)
- Metha Maenhout
- 1 Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max Peters
- 1 Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marco van Vulpen
- 2 Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marinus A Moerland
- 1 Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Richard P Meijer
- 1 Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Paul L Nguyen
- 3 Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Steven J Frank
- 4 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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23
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Barbera F, Triggiani L, Buglione M, Ghirardelli P, Vitali P, Caraffini B, Borghetti P, Greco D, Bardoscia L, Pasinetti N, Costa L, Maddalo M, Ghedi B, La Face B, Magrini SM. Salvage Low Dose Rate Brachytherapy For Recurrent Prostate Cancer After External Beam Radiotherapy: Results From A Single Institution With Focus On Toxicity And Functional Outcomes. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2017; 11:1179554917738765. [PMID: 29151782 PMCID: PMC5680931 DOI: 10.1177/1179554917738765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/24/2017] [Indexed: 12/18/2022]
Abstract
Background/aim: Low dose rate brachytherapy has been used as salvage therapy for locally recurrent prostate cancer (PC) after primary external beam radiation therapy (EBRT), along with surgery and cryotherapy. All these techniques, in particular, when applied to the whole gland, involve a relatively high risk of toxicity and may worsen the patient’s quality of life. Our aim is to evaluate the results of whole-gland salvage brachytherapy (SBT) after primary EBRT in terms of toxicity, functional outcomes, and efficacy. Materials and methods: We retrospectively reviewed clinical data on 19 patients consecutively treated with SBT at our institution between June 2012 and November 2015. Local recurrences were identified with 11C-choline positron emission tomography/computed tomography and pelvic magnetic resonance imaging after biochemical recurrence according to Phoenix criteria (prostate-specific antigen nadir + 2). Low dose rate brachytherapy was performed by 125I permanent seeds implantation to the whole prostate gland, with a prescription dose of 130 Gy. At the time of SBT, only 2 patients were receiving androgen deprivation therapy. Acute and late toxicities were recorded using the CTCAE 4.0 scoring system. Quality of life was assessed using IPSS (International Prostate Symptoms Score) and IIEF (International Index of Erectile Function) questionnaires at baseline and 6, 12, and 24 months after SBT, and the respective mean values were compared using Student t test. Biochemical relapse-free survival (BRFS) was also calculated. Results: Median follow-up after SBT was 24 months. Of 19 patients, 2 patients experienced a G3 cystitis (10.2%) and 1 patient experienced a G4 proctitis (5.3%), respectively. Mean pre-SBT IPSS scores and 6, 12, and 24 months after SBT were 5.84, 10.22, 15.72, and 8.10, respectively. Mean pre-SBT IIEF scores and 6, 12, and 24 months after SBT were 8.42, 3.55, 7.89, and 6.40, respectively. At the time of analysis, only 2 patients showed a biochemical relapse (3-year BRFS 85.2%). The Student t test demonstrated a worsening of functional outcome 6 months and 1 year after treatment but a subsequent improvement 2 years after SBT. Conclusions: Salvage brachytherapy for recurrent PC after primary EBRT seems to be a feasible treatment for selected patients. Our series revealed a severe toxicity peak 6 months and 1 year after local re-treatment and then they decrease. Early BRFS rates are good. However, these are very preliminary results so further patient accrual, long-term follow-up, and prospective trials are needed in the future.
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Affiliation(s)
- F Barbera
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - L Triggiani
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - M Buglione
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - P Ghirardelli
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - P Vitali
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - B Caraffini
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - P Borghetti
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - D Greco
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - L Bardoscia
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - N Pasinetti
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - L Costa
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - M Maddalo
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - B Ghedi
- Medical Physics Department, University and Spedali Civili Hospital, Brescia, Italy
| | - B La Face
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - S M Magrini
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
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24
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Orré M, Piéchaud T, Sargos P, Richaud P, Roubaud G, Thomas L. Oncological and functional results of robotic salvage radical prostatectomy after permanent brachytherapy implants. Cancer Radiother 2017; 21:119-123. [DOI: 10.1016/j.canrad.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 11/12/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022]
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25
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Jereczek-Fossa BA. Re: Stereotactic Body Re-irradiation Therapy for Locally Recurrent Prostate Cancer After External-beam Radiation Therapy: Initial Report. Eur Urol 2017; 71:144. [DOI: 10.1016/j.eururo.2016.08.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/25/2016] [Indexed: 11/16/2022]
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26
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Minimally Invasive Salvage Prostatectomy After Primary Radiation or Ablation Treatment. Urology 2016; 94:111-6. [DOI: 10.1016/j.urology.2016.04.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/03/2016] [Accepted: 04/26/2016] [Indexed: 11/17/2022]
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27
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Zdrojowy R, Dembowski J, Małkiewicz B, Tupikowski K, Krajewski W. Salvage local therapy for radiation-recurrent prostate cancer - where are we? Cent European J Urol 2016; 69:264-270. [PMID: 27729992 PMCID: PMC5057051 DOI: 10.5173/ceju.2016.832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/07/2016] [Accepted: 06/08/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Prostate cancer is the most frequent cancer among males in Europe and a leading cause of cancer deaths, with similar proportion in other developed countries. For more than twenty years, external-beam radiation therapy, alongside with radical prostatectomy, has been used as a primary radical therapeutic approach for localized prostate cancer. Yet, EBRT failures relate to 22-69% following curative radiotherapy (± androgen deprivation therapy). Additionally, a proportion of these men will have a biopsy-proven local recurrence. MATERIAL AND METHODS The Medline and Web of Science databases were searched without a time limit during March 2016 using the terms 'prostate cancer' in conjunction with 'radiotherapy', 'recurrence', 'biochemical', 'salvage', 'brachytherapy', 'prostatectomy', 'HIFU', 'cryotherapy' and 'focal'. The search was limited to the English, Polish, German and Spanish literature. RESULTS Currently, salvage treatment after failed radiotherapy includes radical prostatectomy, brachytherapy and ablative whole-gland therapies, such as cryotherapy and high intensity focused ultrasound. New approaches, so called focal salvage therapy, involve ablation of only the zone of recurrence in order to decrease tissue injury and therefore to diminish morbidity. CONCLUSIONS At present no authoritative recommendations can be concluded because of the absence of randomized data with standardized definitions and protocols. Nevertheless, we believe that local salvage treatment should be at least considered in patients after biochemical relapse following radiotherapy.
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Affiliation(s)
- Romuald Zdrojowy
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Janusz Dembowski
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Tupikowski
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Krajewski
- Urology and Oncologic Urology Department, Wrocław Medical University, Wrocław, Poland
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Stereotactic body re-irradiation therapy for locally recurrent prostate cancer after external-beam radiation therapy: Initial report. Cancer Radiother 2016; 20:275-81. [DOI: 10.1016/j.canrad.2016.03.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022]
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29
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Wojcieszek P, Szlag M, Głowacki G, Cholewka A, Gawkowska-Suwińska M, Kellas-Ślęczka S, Białas B, Fijałkowski M. Salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after primary radiotherapy failure. Radiother Oncol 2016; 119:405-10. [PMID: 27165612 DOI: 10.1016/j.radonc.2016.04.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate high-dose-rate brachytherapy (HDR BT) as a salvage modality for locally recurrent prostate cancer after primary radiotherapy failure. MATERIALS AND METHODS Eighty-three prostate cancer patients, who locally relapsed after radiotherapy, were treated with salvage HDR BT. The schedule was three implantations, every two weeks, with 10Gy per implant, to a total dose of 30Gy. Acute and late toxicity rates were evaluated. Overall survival (OS) and biochemical control were calculated using Kaplan-Meier method. RESULTS Median follow-up after salvage HDR was 41months. The 3-year and 5-year OS were 93% and 86%, respectively. The 3-year and 5-year biochemical disease-free survival (bDFS) were 76% and 67%, respectively. The single factor associated with biochemical control was time to achieve salvage PSA nadir (p-.006). OS was linked significantly with primary nadir level (p-.001) while primary biochemical relapse interval was of borderline significance (p-.07). CONCLUSIONS Salvage HDR BT is a promising treatment option for patients with localized relapse of previously irradiated prostate cancer. Lower PSA nadir after primary radiotherapy and longer primary disease-free interval influence the outcome.
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Affiliation(s)
- Piotr Wojcieszek
- Brachytherapy Department, MSC Memorial Cancer Centre and Institute of Oncology, Gliwice, Ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland.
| | - Marta Szlag
- Radiotherapy and Brachytherapy Treatment Planning Department, MSC Memorial Cancer Centre and Institute of Oncology, Gliwice, Ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland
| | - Grzegorz Głowacki
- Radiotherapy Department, MSC Memorial Cancer Centre and Institute of Oncology, Gliwice, Ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland
| | - Agnieszka Cholewka
- Radiotherapy and Brachytherapy Treatment Planning Department, MSC Memorial Cancer Centre and Institute of Oncology, Gliwice, Ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland
| | - Marzena Gawkowska-Suwińska
- III Department of Radiotherapy and Chemotherapy, MSC Memorial Cancer Centre and Institute of Oncology, Gliwice, Ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland
| | - Sylwia Kellas-Ślęczka
- Brachytherapy Department, MSC Memorial Cancer Centre and Institute of Oncology, Gliwice, Ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland
| | - Brygida Białas
- Brachytherapy Department, MSC Memorial Cancer Centre and Institute of Oncology, Gliwice, Ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland
| | - Marek Fijałkowski
- Brachytherapy Department, MSC Memorial Cancer Centre and Institute of Oncology, Gliwice, Ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland
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Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review. World J Urol 2016; 34:1521-1531. [PMID: 27012712 PMCID: PMC5063906 DOI: 10.1007/s00345-016-1811-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/11/2016] [Indexed: 11/16/2022] Open
Abstract
Background/Aim Patients with locally recurrent prostate cancer after primary radiotherapy can be eligible for salvage treatment. Whole-gland salvage techniques carry a high risk of toxicity. A focal salvage approach might reduce the risk of adverse events while maintaining cancer control in carefully selected patients. The aim of this review was to evaluate current literature to assess whether focal salvage leads to a comparable or favourable recurrence rate and less toxicity compared to whole-gland salvage. Methods A literature search was performed using PubMed, Embase and the Cochrane Library. A total of 3015 articles were screened and assessed for quality. Eight papers [on focal cryoablation (n = 3), brachytherapy (n = 3) and high-intensity focused ultrasound (n = 2)] were used to report outcomes. Results One-, 2-, 3- and 5-year biochemical disease-free survival (BDFS) ranges for focal salvage are, respectively, 69–100, 49–100, 50–91 and 46.5–54.5 %. Severe genitourinary, gastrointestinal and sexual function toxicity rates are 0–33.3 %. One study directly compares focal to whole-gland salvage cryotherapy, showing 5-year BDFS of, respectively, 54.4 and 86.5 % with lower toxicity rates for focal salvage patients. Conclusion Provisional data suggest that BDFS rates of focal salvage are in line with those of whole-gland approaches. There is evidence that focal salvage could decrease severe toxicity and preserve erectile function. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1811-9) contains supplementary material, which is available to authorized users.
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31
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Peters M, van der Voort van Zyp JRN, Moerland MA, Hoekstra CJ, van de Pol S, Westendorp H, Maenhout M, Kattevilder R, Verkooijen HM, van Rossum PSN, Ahmed HU, Shah TT, Emberton M, van Vulpen M. Multivariable model development and internal validation for prostate cancer specific survival and overall survival after whole-gland salvage Iodine-125 prostate brachytherapy. Radiother Oncol 2016; 119:104-10. [PMID: 26897512 DOI: 10.1016/j.radonc.2016.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Whole-gland salvage Iodine-125-brachytherapy is a potentially curative treatment strategy for localised prostate cancer (PCa) recurrences after radiotherapy. Prognostic factors influencing PCa-specific and overall survival (PCaSS & OS) are not known. The objective of this study was to develop a multivariable, internally validated prognostic model for survival after whole-gland salvage I-125-brachytherapy. MATERIALS AND METHODS Whole-gland salvage I-125-brachytherapy patients treated in the Netherlands from 1993-2010 were included. Eligible patients had a transrectal ultrasound-guided biopsy-confirmed localised recurrence after biochemical failure (clinical judgement, ASTRO or Phoenix-definition). Recurrences were assessed clinically and with CT and/or MRI. Metastases were excluded using CT/MRI and technetium-99m scintigraphy. Multivariable Cox-regression was used to assess the predictive value of clinical characteristics in relation to PCa-specific and overall mortality. PCa-specific mortality was defined as patients dying with distant metastases present. Missing data were handled using multiple imputation (20 imputed sets). Internal validation was performed and the C-statistic calculated. Calibration plots were created to visually assess the goodness-of-fit of the final model. Optimism-corrected survival proportions were calculated. All analyses were performed according to the TRIPOD statement. RESULTS Median total follow-up was 78months (range 5-139). A total of 62 patients were treated, of which 28 (45%) died from PCa after mean (±SD) 82 (±36) months. Overall, 36 patients (58%) patients died after mean 84 (±40) months. PSA doubling time (PSADT) remained a predictive factor for both types of mortality (PCa-specific and overall): corrected hazard ratio's (HR's) 0.92 (95% CI: 0.86-0.98, p=0.02) and 0.94 (95% CI: 0.90-0.99, p=0.01), respectively (C-statistics 0.71 and 0.69, respectively). Calibration was accurate up to 96month follow-up. Over 80% of patients can survive 8years if PSADT>24months (PCaSS) and >33months (OS). Only approximately 50% survival is achieved with a PSADT of 12months. CONCLUSION A PSADT of respectively >24months and >33months can result in >80% probability of PCa- specific and overall survival 8years after whole-gland salvage I-125-brachytherapy. Survival should be weighed against toxicity from a salvage procedure. Larger series and external validation are necessary.
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Affiliation(s)
- Max Peters
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands.
| | | | - Marinus A Moerland
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | | | | | | | - Metha Maenhout
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | | | | | - Peter S N van Rossum
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK
| | - Taimur T Shah
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK; Department of Urology, Whittington Hospital NHS Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK; NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, UK
| | - Marco van Vulpen
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
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De Bari B, Alongi F, Mortellaro G, Mazzola R, Schiappacasse L, Guckenberger M. Spinal metastases: Is stereotactic body radiation therapy supported by evidences? Crit Rev Oncol Hematol 2016; 98:147-58. [DOI: 10.1016/j.critrevonc.2015.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/01/2015] [Accepted: 11/04/2015] [Indexed: 12/21/2022] Open
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Rectal dose constraints for salvage iodine-125 prostate brachytherapy. Brachytherapy 2016; 15:85-93. [DOI: 10.1016/j.brachy.2015.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
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Siddiqui KM, Billia M, Williams A, Alzahrani A, Chin JL. Comparative morbidity of ablative energy-based salvage treatments for radio-recurrent prostate cancer. Can Urol Assoc J 2015; 9:325-9. [PMID: 26644804 DOI: 10.5489/cuaj.3113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We compared the morbidity of whole gland salvage ablation using cryotherapy (CRYO) and high-intensity focused ultrasound (HIFU) for radio recurrent prostate cancer at a single centre over a 17-year period. METHODS Patients were divided in 3 cohorts. Group 1 included the first 65 patients treated with CRYO (1995-1998); Group 2 included the last 65 patients treated with CRYO (2002-2004), and Group 3 included 65 patients treated with HIFU (2006-2011). We analyzed the complications reported within at least 90 days of treatment or up to the last follow-up. RESULTS We tallied Clavien grade complications. For Groups 1, 2 and 3, we recorded the following Clavien I-II complications: 78, 49 and 13, respectively. For Clavien grade IIIa, 2, 5 and 4 for Groups 1, 2 and 3, respectively. For Clavien grade IIIb, 8, 2 and 3 for Groups 1, 2 and 3, respectively. Clavien grade II complications were statistically higher in Group 1 versus Group 2 (p = 0.005) and in Group 2 versus Group 3 (p = 0.0001). The rate of mild-moderate incontinence was significantly higher in the CRYO group compared to the HIFU cohort (p ≤ 0.05). The rate of urinary retention was significantly higher in Group 2 compared to Group 3 (p = 0.0005). The rates of severe incontinence (range: 1.5%-5%), need for surgical intervention (uniform at 1.5%), and recto-urethral fistulae (range: 1.5%-3%) were not statistically different. CONCLUSIONS CRYO was associated with higher overall morbidity. The morbidity during the early experience with HIFU was lower than both subgroups of CRYO. This may reflect the advancement of technology or cumulative learning experience.
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Affiliation(s)
| | | | | | - Ali Alzahrani
- Department of Urology, University of Dammam, Saudi Arabia
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Peters M, van der Voort van Zyp J, Hoekstra C, Westendorp H, van de Pol S, Moerland M, Maenhout M, Kattevilder R, van Vulpen M. Urethral and bladder dosimetry of total and focal salvage Iodine-125 prostate brachytherapy: Late toxicity and dose constraints. Radiother Oncol 2015; 117:262-9. [DOI: 10.1016/j.radonc.2015.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/22/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
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Salomon L, Ploussard G, Hennequin C, Richaud P, Soulié M. Traitements complémentaires de la chirurgie du cancer de la prostate et chirurgie de la récidive. Prog Urol 2015; 25:1086-107. [DOI: 10.1016/j.purol.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
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Zerini D, Jereczek-Fossa BA, Fodor C, Bazzani F, Maucieri A, Ronchi S, Ferrario S, Colangione SP, Gerardi MA, Caputo M, Cecconi A, Gherardi F, Vavassori A, Comi S, Cambria R, Garibaldi C, Cattani F, De Cobelli O, Orecchia R. Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer. Br J Radiol 2015; 88:20150197. [PMID: 26055506 DOI: 10.1259/bjr.20150197] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate external beam reirradiation (re-EBRT) delivered to the prostate/prostatic bed for local recurrence, after radical or adjuvant/salvage radiotherapy (RT). METHODS 32 patients received re-EBRT between February 2008 and October 2013. All patients had clinical/radiological local relapse in the prostate or prostatic bed and no distant metastasis. re-EBRT was delivered with selective RT technologies [stereotactic RT including CyberKnife(TM) (Accuray, Sunnyvale, CA); image-guidance and intensity-modulated RT etc.]. Toxicity was evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Biochemical control was assessed according to the Phoenix definition (NADIR + 2 ng ml(-1)). RESULTS Acute urinary toxicity: G0, 24 patients; G1, 6 patients; G2, 2 patients. Acute rectal toxicity: G0, 28 patients; G1, 2 patients; and G2, 1 patient. Late urinary toxicity (evaluated in 30 cases): G0, 23 patients; G1, 6 patients; G2, 1 patient. Late renal toxicity: G0, 25 patients; G1, 5 patients. A mean follow-up of 21.3 months after re-EBRT showed that 13 patients were free of cancer, 3 were alive with biochemical relapse and 12 patients were alive with clinically evident disease. Four patients had died: two of disease progression and two of other causes. CONCLUSION re-EBRT using modern technology is a feasible approach for local prostate cancer recurrence offering 2-year tumour control in about half of the patients. Toxicity of re-EBRT is low. Future studies are needed to identify the patients who would benefit most from this treatment. ADVANCES IN KNOWLEDGE Our series, based on experience in one hospital alone, shows that re-EBRT for local relapse of prostate cancer is feasible and offers a 2-year cure in about half of the patients.
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Affiliation(s)
- D Zerini
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - B A Jereczek-Fossa
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - C Fodor
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Bazzani
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - A Maucieri
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S Ronchi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S Ferrario
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - S P Colangione
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - M A Gerardi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - M Caputo
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy
| | - A Cecconi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - F Gherardi
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - A Vavassori
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - S Comi
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - R Cambria
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - C Garibaldi
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - F Cattani
- 3 Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - O De Cobelli
- 2 Department of Health Sciences, University of Milan, Milan, Italy.,4 Department of Urology, European Institute of Oncology, Milan, Italy
| | - R Orecchia
- 1 Department of Radiotherapy, European Institute of Oncology, Milan, Italy.,2 Department of Health Sciences, University of Milan, Milan, Italy.,5 Clinical Division of the National Center of Oncological Hadrontherapy, Pavia, Italy
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Stereotactic Body Radiation Therapy Salvage Reirradiation of Radiorecurrent Prostatic Carcinoma Relapsed in the Prostatic Bed. TUMORI JOURNAL 2015; 101:e57-9. [DOI: 10.5301/tj.5000251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 12/30/2022]
Abstract
A 67-year-old man presented with a slow increase of prostate-specific antigen value after radical prostatectomy and postoperative radiotherapy for prostate cancer. The patient had received 3D conformal radiotherapy to a total dose of 66 Gy in 33 fractions of 2 Gy each on the prostatic bed. Three years later, a macroscopic local failure was diagnosed at the apical region. The patient could not receive androgenic deprivation therapy or other types of treatment owing to comorbid conditions. Thus, stereotactic body radiation therapy with helical image-guided tomotherapy was administered. The total dose was 30 Gy in 5 consecutive fractions of 6 Gy each to the site of the local failure. The treatment was preceded by a transperineal-guided injection of a self-absorbable hydrogel into the prostatic bed, between rectum and bladder, in order to preserve the rectal wall, which already had received significant doses from the first radiation course. Radiation therapy was well-tolerated. After a follow-up period of 6 months, the patient remains healthy, and there has been no further evidence of metastatic spread or recurrence.
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D’Angelillo RM, Franco P, De Bari B, Fiorentino A, Arcangeli S, Alongi F. Combination of androgen deprivation therapy and radiotherapy for localized prostate cancer in the contemporary era. Crit Rev Oncol Hematol 2015; 93:136-48. [DOI: 10.1016/j.critrevonc.2014.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 08/18/2014] [Accepted: 10/01/2014] [Indexed: 12/31/2022] Open
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Soulié M, Salomon L. Traitements de rattrapage après irradiation prostatique : place de l’urologue. Cancer Radiother 2014; 18:535-9. [DOI: 10.1016/j.canrad.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 11/15/2022]
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TGF-β1 mediates the radiation response of prostate cancer. J Mol Med (Berl) 2014; 93:73-82. [PMID: 25228112 DOI: 10.1007/s00109-014-1206-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/19/2014] [Accepted: 09/02/2014] [Indexed: 12/12/2022]
Abstract
UNLABELLED Radiotherapy is the main treatment modality for prostate cancer. This study investigated the role of TGF-β1 in biological sequelae and tumor regrowth following irradiation, which are critical for the clinical radiation response of prostate cancer. Human and murine prostate cancer cell lines, and corresponding hormone-refractory (HR) cells, were used to examine the radiation response by clonogenic assays in vitro and tumor growth delay in vivo. Biological changes after irradiation, including cell death and tumor regrowth, were examined by experimental manipulation of TGF-β1 signaling. The correlations among tumor radiation responses, TGF-β1 levels, and regulatory T cells (Tregs) recruitment were also evaluated using animal experiments. HR prostate cancer cells appeared more radioresistant and had higher expression of TGF-β1 compared to hormone-sensitive (HS) cells. TGF-β1 expression was positively linked to irradiation and radioresistance, as demonstrated by in vitro and in vivo experiments. Inhibition of TGF-β1 increased tumor inhibition and DNA damage after irradiation. When mice were irradiated with a sub-lethal dose, the regrowth of irradiated tumors was significantly correlated with TGF-β1 levels and Tregs accumulation in vivo. Furthermore, blocking TGF-β1 clearly attenuated Tregs accumulation and tumor regrowth following treatment. These data demonstrate that TGF-β1 is important in determining the radiation response of prostate cancer, including tumor cell killing and the tumor microenvironment. Therefore, concurrent treatment with a TGF-β1 inhibitor is a potential therapeutic strategy for increasing the radiation response of prostate cancer, particularly for more aggressive or HR cancer cells. KEY MESSAGE • HR prostate cancer cells appeared more radioresistant and had higher expression of TGF-β1. • TGF-β1 was positively linked to the radiation resistance of prostate cancer. • Tumor regrowth following irradiation was significantly correlated with TGF-β1 and Tregs levels. • Blocking TGF-β1 significantly attenuated RT-induced DNA repair and Tregs. • TGF-β1 inhibitor increases the radiation response of HR cancer cells.
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Retreatment for prostate cancer with stereotactic body radiation therapy (SBRT): Feasible or foolhardy? Rep Pract Oncol Radiother 2014; 20:425-9. [PMID: 26696782 DOI: 10.1016/j.rpor.2014.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/26/2014] [Accepted: 08/06/2014] [Indexed: 11/21/2022] Open
Abstract
The most popular therapeutic option in the management of radio-recurrent prostatic carcinoma is represented by the androgen deprivation therapy, that however should be considered only palliative and hampered by potential adverse effects of testosterone suppression. Local therapies such as surgery, cryoablation or brachytherapy might be curative choices for patients in good conditions and with a long-life expectancy, but at cost of significant risk of failure and severe toxicity. The administration of stereotactic body radiation therapy (SBRT) in this setting have come about because of tremendous technologic advances in image guidance and treatment delivery techniques that enable the delivery of large doses to tumor with reduced margins and high gradients outside the target, thereby reducing the volume of rectum which already received significant doses from primary radiotherapy. So far, very modest data are available to support its employment. Rationale, clinical experience, and challenges are herein reviewed and discussed.
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De Bari B, Alongi F, Lestrade L, Giammarile F. Choline-PET in prostate cancer management: The point of view of the radiation oncologist. Crit Rev Oncol Hematol 2014; 91:234-47. [DOI: 10.1016/j.critrevonc.2014.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 03/12/2014] [Accepted: 04/17/2014] [Indexed: 12/26/2022] Open
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Salji M, Jones R, Paul J, Birrell F, Dixon-Hughes J, Hutchison C, Johansen TEB, Greene D, Parr N, Leung HY. Feasibility study of a randomised controlled trial to compare (deferred) androgen deprivation therapy and cryotherapy in men with localised radiation-recurrent prostate cancer. Br J Cancer 2014; 111:424-9. [PMID: 24946001 PMCID: PMC4119985 DOI: 10.1038/bjc.2014.316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/09/2014] [Accepted: 05/12/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Salvage therapeutic options for biochemical failure after primary radiation-based therapy include radical prostatectomy, cryoablation, high-intensity focused ultrasound (HIFU), brachytherapy (for post-EBRT patients) and androgen deprivation therapy (ADT). ADT and salvage prostate cryoablation (SPC) are two commonly considered treatment options for RRPC. However, there is an urgent need for high-quality clinical studies to support evidence-based decisions on treatment choice. Our study aims to determine the feasibility of randomising men with RRPC for treatment with ADT and SPC. METHODS The randomised controlled trial (CROP) was developed, which incorporated protocols to assess parameters relating to cryotherapy procedures and provide training workshops for optimising patient recruitment. Analysis of data from the recruitment phase and patient questionnaires was performed. RESULTS Over a period of 18 months, 39 patients were screened for eligibility. Overall 28 patients were offered entry into the trial, but only 7 agreed to randomisation. The majority reason for declining entry into the trial was an unwillingness to be randomised into the study. 'Having the chance of getting cryotherapy' was the major reason for accepting the trial. Despite difficulty in retrieving cryotherapy temperature parameters from prior cases, 9 of 11 cryotherapy centres progressed through the Cryotherapists Qualification Process (CQP) and were approved for recruiting into the CROP study. CONCLUSIONS Conveying equipoise between the two study arms for a salvage therapy was challenging. The use of delayed androgen therapy may have been seen as an inferior option. Future cohort studies into available salvage options (including prostate cryotherapy) for RRPC may be more acceptable to patients than randomisation within an RCT.
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Affiliation(s)
- M Salji
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - R Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Cancer Research UK Glasgow Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - J Paul
- Cancer Research UK Glasgow Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - F Birrell
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J Dixon-Hughes
- Cancer Research UK Glasgow Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - C Hutchison
- Cancer Research UK Glasgow Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - T E B Johansen
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - D Greene
- Sunderland Royal Hospital, City Hospitals Sunderland, Sunderland, UK
| | - N Parr
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - H Y Leung
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Sunderland Royal Hospital, City Hospitals Sunderland, Sunderland, UK
- Beatson Institute, Glasgow, UK
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De Bari B, Fiorentino A, Arcangeli S, Franco P, D'Angelillo RM, Alongi F. From radiobiology to technology: what is changing in radiotherapy for prostate cancer. Expert Rev Anticancer Ther 2014; 14:553-64. [DOI: 10.1586/14737140.2014.883282] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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