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Santamaria R, Zaffaroni M, Vincini MG, Colombi L, Gaeta A, Mastroleo F, Corrao G, Zerini D, Villa R, Mazzola GC, Alessi S, Luzzago S, Mistretta FA, Musi G, De Cobelli O, Gandini S, Kuncman L, Cattani F, Ceci F, Petralia G, Marvaso G, Jereczek-Fossa BA. Image-Guided Stereotactic Body Radiotherapy on Detectable Prostate Bed Recurrence after Prostatectomy in RT-Naïve Patients. Life (Basel) 2024; 14:870. [PMID: 39063623 PMCID: PMC11277978 DOI: 10.3390/life14070870] [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: 05/29/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Purpose or Objective-The aim of the study is to evaluate the efficacy and safety of SBRT on detectable prostate bed recurrence in RT-naïve prostate cancer patients. MATERIALS AND METHODS Eighty-six patients who underwent SBRT for macroscopic bed recurrence after prostatectomy were retrospectively included. Patients were treated based on mpMRI or choline/PSMA PET. RESULTS The median time to biochemical relapse (BCR) after RP was 46 months, with a median PSA at restaging of 1.04 ng/mL. Forty-six patients were staged with mpMRI and choline/PSMA PET, while ten and thirty were treated based on PET and MRI only, respectively. Only one late G ≥ 2 GI toxicity was observed. With a median BCR follow-up of 14 months, twenty-nine patients experienced a BCR with a median PSA at recurrence of 1.66 ng/mL and a median survival free from the event of 40.1 months. The median time to BCR was 17.9 months. Twenty-seven patients had clinical relapse (CR), with a median CR follow-up of 16.27 months and a median time to CR of 23.0 months. Biochemical recurrence-free survival at one and two years was 88% and 66%, respectively, while clinical recurrence-free survival at one and two years was 92% and 82%, respectively. Regarding local relapses, seven were in the field of treatment, while eight of them were outside the field of treatment. CONCLUSIONS Data showed that SBRT targeting only the macroscopic bed recurrence instead of the whole prostate bed is safe and effective. Additional data and longer follow-ups will provide a clearer indication of the appropriate treatment and staging methodology for these patients.
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Affiliation(s)
- Riccardo Santamaria
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Lorenzo Colombi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Aurora Gaeta
- Department of Experimental Oncology, European Institute of Oncology IRCCS, 20139 Milan, Italy; (A.G.); (S.G.)
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Giulia Corrao
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Dario Zerini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Riccardo Villa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Giovanni Carlo Mazzola
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Sarah Alessi
- Division of Radiology, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Stefano Luzzago
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Francesco Alessandro Mistretta
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, 20139 Milan, Italy; (A.G.); (S.G.)
| | - Lukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, 90-419 Lodz, Poland;
- Department of External Beam Radiotherapy, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, 93-513 Lodz, Poland
| | - Federica Cattani
- Medical Physics Unit, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Nuclear Medicine, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Radiology, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
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Rodrigues I, Ferreira C, Gonçalves J, Carvalho L, Oliveira J, Castro C, Oliveira Â. Pathological stage, surgical margin and lymphovascular invasion as prognostic factors after salvage radiotherapy for post-prostatectomy relapsed prostate cancer - outcomes and optimization strategies. Rep Pract Oncol Radiother 2021; 26:535-544. [PMID: 34434569 DOI: 10.5603/rpor.a2021.0070] [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: 10/22/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Salvage radiotherapy (sRT) is the main potentially curative treatment after biochemical failure/locoregional relapse post-radical prostatectomy (RP). The aim of the study was to characterize the population who underwent sRT after RP at our Department, to understand the influence of several potential prognosis factors, and to determine possible optimization strategies. Materials and methods We retrospectively analyzed patients undergoing sRT at our department between 2012 and 2017, evaluating patient, tumor and treatment characteristics, restaging procedures and clinical outcomes - namely biochemical relapse-free survival (BC-RFS), clinical relapse-free survival (C-RFS), additional hormone therapy-free survival (HT-FS) and overall survival (OS). We assessed potential prognostic factors by univariate and multivariate models (MVA). Results We included 277 patients (median age 68 years). Median pre-sRT PSA was > 0.5ng/mL in 54.9%. All underwent prostate bed irradiation. Pelvic lymph nodes were included in 9.7%. Outcome analysis was performed for 264 patients (35.6 months median follow-up). At 3 years, BC-RFS was 61.4%, C-RFS was 81.3%, HT-FS was 79.9% and OS was 96.6%. Most relapses occurred in regional lymph nodes only (47.9% patients who relapsed). On MVA, lymphovascular invasion, advanced pT-stages and negative margins negatively influenced BC-RFS (p = 0.029, p = 0.002 and p < 0.001) and HT-FS (p = 0.001, p = 0.029 and p = 0.002). C-RFS was worsened by lymphovascular invasion (p = 0.009) and negative margins (p = 0.015). These had no effect on OS. BC-RFS and HT-FS were improved when sRT started while PSA ≤ 0.5 ng/mL (p < 0.05). Conclusion Lymphovascular invasion, higher pT-stages and negative margins negatively affected prognosis. An early start of sRT (PSA ≤ 0.5 ng/mL) predicted better BC-RFS and HT-FS.
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Affiliation(s)
- Isabel Rodrigues
- External Radiotherapy Department, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E., Portugal
| | - Carolina Ferreira
- External Radiotherapy Department, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E., Portugal.,Urology Clinic, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E, Portugal
| | - Joana Gonçalves
- External Radiotherapy Department, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E., Portugal.,Urology Clinic, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E, Portugal
| | - Luísa Carvalho
- External Radiotherapy Department, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E., Portugal
| | - Jorge Oliveira
- Urology Clinic, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E, Portugal
| | - Carla Castro
- External Radiotherapy Department, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E., Portugal.,Urology Clinic, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E, Portugal
| | - Ângelo Oliveira
- External Radiotherapy Department, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E., Portugal.,Urology Clinic, Instituto Português de Oncologia do Porto Francisco Gentil, E.P.E, Portugal
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