Salvage Stereotactic Reirradiation for Local Recurrence in the Prostatic Bed After Prostatectomy: A Retrospective Multicenter Study.
Options
BORIS DOI
Publisher DOI
PubMed ID
37012102
Description
BACKGROUND
Management of local recurrence of prostate cancer (PCa) in the prostatic bed after radical prostatectomy (RP) and radiotherapy remains challenging.
OBJECTIVE
To assess the efficacy and safety of salvage stereotactic body radiotherapy (SBRT) reirradiation in this setting and evaluate prognostic factors.
DESIGN, SETTING, AND PARTICIPANTS
We conducted a large multicenter retrospective series that included 117 patients who were treated with salvage SBRT for local recurrence in the prostatic bed after RP and radiotherapy in 11 centers across three countries.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Progression-free survival (PFS; biochemical, clinical, or both) was estimated using the Kaplan-Meier method. Biochemical recurrence was defined as prostate-specific antigen nadir +0.2 ng/ml, confirmed by a second increasing measure. The cumulative incidence of late toxicities was estimated using the Kalbfleisch-Prentice method by considering recurrence or death as a competing event.
RESULTS AND LIMITATIONS
The median follow-up was 19.5 mo. The median SBRT dose was 35 Gy. The median PFS was 23.5 mo (95% confidence interval [95% CI], 17.6-33.2). In the multivariable models, the volume of the recurrence and its contact with the urethrovesical anastomosis were significantly associated with PFS (hazard ratio [HR]/10 cm3 = 1.46; 95% CI, 1.08-1.96; p = 0.01 and HR = 3.35; 95% CI, 1.38-8.16; p = 0.008, respectively). The 3-yr cumulative incidence of grade ≥2 late GU or GI toxicity was 18% (95% CI, 10-26). In the multivariable analysis, a recurrence in contact with the urethrovesical anastomosis and D2% of the bladder were significantly associated with late toxicities of any grade (HR = 3.65; 95% CI, 1.61-8.24; p = 0.002 and HR/10 Gy = 1.88; 95% CI, 1.12-3.16; p = 0.02, respectively).
CONCLUSIONS
Salvage SBRT for local recurrence in the prostate bed may offer encouraging control and acceptable toxicity. Therefore, further prospective studies are warranted.
PATIENT SUMMARY
We found that salvage stereotactic body radiotherapy after surgery and radiotherapy allows for encouraging control and acceptable toxicity in locally relapsed prostate cancer.
Management of local recurrence of prostate cancer (PCa) in the prostatic bed after radical prostatectomy (RP) and radiotherapy remains challenging.
OBJECTIVE
To assess the efficacy and safety of salvage stereotactic body radiotherapy (SBRT) reirradiation in this setting and evaluate prognostic factors.
DESIGN, SETTING, AND PARTICIPANTS
We conducted a large multicenter retrospective series that included 117 patients who were treated with salvage SBRT for local recurrence in the prostatic bed after RP and radiotherapy in 11 centers across three countries.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Progression-free survival (PFS; biochemical, clinical, or both) was estimated using the Kaplan-Meier method. Biochemical recurrence was defined as prostate-specific antigen nadir +0.2 ng/ml, confirmed by a second increasing measure. The cumulative incidence of late toxicities was estimated using the Kalbfleisch-Prentice method by considering recurrence or death as a competing event.
RESULTS AND LIMITATIONS
The median follow-up was 19.5 mo. The median SBRT dose was 35 Gy. The median PFS was 23.5 mo (95% confidence interval [95% CI], 17.6-33.2). In the multivariable models, the volume of the recurrence and its contact with the urethrovesical anastomosis were significantly associated with PFS (hazard ratio [HR]/10 cm3 = 1.46; 95% CI, 1.08-1.96; p = 0.01 and HR = 3.35; 95% CI, 1.38-8.16; p = 0.008, respectively). The 3-yr cumulative incidence of grade ≥2 late GU or GI toxicity was 18% (95% CI, 10-26). In the multivariable analysis, a recurrence in contact with the urethrovesical anastomosis and D2% of the bladder were significantly associated with late toxicities of any grade (HR = 3.65; 95% CI, 1.61-8.24; p = 0.002 and HR/10 Gy = 1.88; 95% CI, 1.12-3.16; p = 0.02, respectively).
CONCLUSIONS
Salvage SBRT for local recurrence in the prostate bed may offer encouraging control and acceptable toxicity. Therefore, further prospective studies are warranted.
PATIENT SUMMARY
We found that salvage stereotactic body radiotherapy after surgery and radiotherapy allows for encouraging control and acceptable toxicity in locally relapsed prostate cancer.
Date of Publication
2023-06
Publication Type
Article
Subject(s)
Keyword(s)
Prostate cancer Prostatic bed Radical prostatectomy Recurrence Reirradiation Salvage stereotactic radiation therapy
Language(s)
en
Contributor(s)
Archer, Paul | |
Marvaso, Giulia | |
Detti, Beatrice | |
Colombo, Francesca | |
Francolini, Giulio | |
Vandendorpe, Benjamin | |
Thananayagam, Marie Albert | |
Baty, Manon | |
De Crevoisier, Renaud | |
Alongi, Filippo | |
Nicosia, Luca | |
Scher, Nathaniel | |
Toledano, Alain | |
Di Muzio, Nadia | |
Fodor, Andrei | |
Zilli, Thomas | |
Franzese, Ciro | |
Scorsetti, Marta | |
Triggiani, Luca | |
Aymes, Estelle | |
Le Deley, Marie-Cécile | |
Alicja Jereczek-Fossa, Barbara | |
Pasquier, David |
Additional Credits
Series
European urology oncology
Publisher
Elsevier
ISSN
2588-9311
Access(Rights)
restricted