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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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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 2018; 92:20180494. [PMID: 30379566 DOI: 10.1259/bjr.20180494] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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)
- Barbara Alicja Jereczek-Fossa
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Damaris Patricia Rojas
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Dario Zerini
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
| | - Cristiana Fodor
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
| | - Anna Viola
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Giuseppe Fanetti
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Stefania Volpe
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy.,2 Department of Oncology and Hemato-oncology, University of Milan , Milan , Italy
| | - Rosa Luraschi
- 3 Unit of Medical Physics, European Institute of Oncology IRCCS , Milan , Italy
| | - Alessia Bazani
- 3 Unit of Medical Physics, European Institute of Oncology IRCCS , Milan , Italy
| | - Elena Rondi
- 3 Unit of Medical Physics, European Institute of Oncology IRCCS , Milan , Italy
| | - Federica Cattani
- 3 Unit of Medical Physics, European Institute of Oncology IRCCS , Milan , Italy
| | - Andrea Vavassori
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
| | - Cristina Garibaldi
- 4 Radiation Research Unit, European Institute of Oncology IRCCS , Milano , Italy
| | - Sarah Alessi
- 5 Division of Radiology, European Institute of Oncology IRCCS , Milan , Italy
| | - Paola Pricolo
- 5 Division of Radiology, European Institute of Oncology IRCCS , Milan , Italy
| | - Giuseppe Petralia
- 5 Division of Radiology, European Institute of Oncology IRCCS , Milan , Italy
| | - Gabriele Cozzi
- 6 Division of Urology, European Institute of Oncology IRCCS , Milan , Italy
| | - Ottavio De Cobelli
- 6 Division of Urology, European Institute of Oncology IRCCS , Milan , Italy
| | - Gennaro Musi
- 6 Division of Urology, European Institute of Oncology IRCCS , Milan , Italy
| | - Roberto Orecchia
- 7 Scientific Directorate, European Institute of Oncology IRCCS , Milan , Italy
| | - Giulia Marvaso
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
| | - Delia Ciardo
- 1 Division of Radiation Oncology, European Institute of Oncology IRCCS , Milan , Italy
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