Abstract
Background and objective
The optimal management of prostate cancer (PC) recurrences after definitive or postoperative radiotherapy (RT) is still controversial. The aim of the present retrospective study was to report the preliminary clinical results and toxicity of a mono-institutional series of patients re-irradiated with linac-based SBRT in recurrent prostate cancer.
Methods
Inclusion criteria were previous definitive or adjuvant/salvage RT, evidence of biochemical recurrence and radiological detection of local relapse (Magnetic Resonance Imaging or PSMA/choline-Positron Emission Tomography), and IPSS <10. Toxicity was assessed according to Common Terminology Criteria for Adverse Events v4.0.
Results
Between 12/2014 and 12/2019, 24 patients with median age 75 years (65–89) underwent re-RT for PC recurrence. Median follow-up was 21 months (2–68). The recurrences occurred in 13 cases within the prostate and in 11 cases within the prostate bed. All patients were treated with SBRT to a median total dose of 30 Gy (25–36 Gy) in 5–6 fractions, and simultaneous androgen deprivation therapy was administered in 4 patients. Acute toxicity was G1 in 8.3% and G2 in 12.5% for genitourinary (GU), no acute gastrointestinal (GI) toxicity occurred. Concerning late side effects, 19.7% of patients were found to have ≥G2 GU toxicity, including one G3 urethral stenosis. Only one case of G1 late GI toxicity occurred and no ≥G2. The 2‑year overall survival was 95%. The 1‑ and 2‑year biochemical relapse-free survival (BRFS) and progression-free survival (PFS) rates were 80 and 54.9%, respectively.
Conclusion
Despite of the heterogeneity of the sample, linac-based SBRT as a salvage treatment in previously irradiated locally recurrent PC patients seems to be a safe and feasible treatment option. Long-term data are pending.
Similar content being viewed by others
References
Mazzola R, Cuccia F, Figlia V, Giaj-Levra N, Nicosia L, Ricchetti F, Rigo M, Pasinetti N, Salgarello M, Alongi F (2019) New metabolic tracers for detectable PSA levels in the post-prostatectomy setting: is the era of melting glaciers upcoming? Transl Androl Urol 8(Suppl 5):S538–S541. https://doi.org/10.21037/tau.2019.12.34
De Bari B, Mazzola R, Aiello D, Aloi D, Gatta R, Corradini S, Salgarello M, Alongi F (2019) (68Ga)-PSMA-PET/CT for the detection of postoperative prostate cancer recurrence: Possible implications on treatment volumes for radiation therapy. Cancer Radiother 23(3):194–200. https://doi.org/10.1016/j.canrad.2018.09.003
De Bari B, Mazzola R, Aiello D, Fersino S, Gregucci F, Alongi P, Nicodemo M, Cavalleri S, Salgarello M, Alongi F (2018) 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 123(9):719–725
De Bari B, Arcangeli S, Ciardo D, Mazzola R, Alongi F, Russi EG, Santoni R, Magrini SM, Jereczek-Fossa BA (2016) Extreme hypofractionation for early prostate cancer: Biology meets technology. Cancer Treat Rev 50:48–60. https://doi.org/10.1016/j.ctrv.2016.08.005
Valeriani M, Carnevale A, Agolli L, Bonome P, Montalto A, Nicosia L, Osti MF, De Sanctis V, Minniti G, Maurizi Enrici R (2014) Image-guided hypofractionated radiotherapy in low-risk prostate cancer patients. Biomed Res Int. https://doi.org/10.1155/2014/465175
Nicosia L, Mazzola R, Rigo M, Figlia V, Giaj-Levra N, Napoli G, Ricchetti F, Corradini S, Ruggieri R, Alongi F (2019) Moderate versus extreme hypofractionated radiotherapy: a toxicity comparative analysis in low- and favorable intermediate-risk prostate cancer patients. J Cancer Res Clin Oncol 145(10):2547–2554. https://doi.org/10.1007/s00432-019-02983-3
Créhange G, Roach M 3rd, Martin E, Cormier L, Peiffert D, Cochet A, Chapet O, Supiot S, Cosset JM, Bolla M, Chung HT (2014) Salvage reirradiation for locoregional failure after radiation therapy for prostate cancer: who, when, where and how? Cancer Radiother 18(5-6):524–534. https://doi.org/10.1016/j.canrad.2014.07.153
Alongi F, De Bari B, Campostrini F, Arcangeli S, Matei DV, Lopci E, Petralia G, Bellomi M, Chiti A, Magrini SM, Scorsetti M, Orecchia R, Jereczek-Fossa BA (2013) Salvage therapy of intraprostatic failure after radical external-beam radiotherapy for prostate cancer: a review. Crit Rev Oncol Hematol 88(3):550–563. https://doi.org/10.1016/j.critrevonc.2013.07.009
Cooperberg MR, Vickers AJ, Broering JM, Carroll PR (2010) Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer 116:5226–5234
Murota-Kawano A, Nakano M, Hongo S, Shoji S, Nagata Y, Uchida T (2010) Salvage high-intensity focused ultrasound for biopsy-confirmed local recurrence of prostate cancer after radical prostatectomy. BJU Int 105(12):1642–1645. https://doi.org/10.1111/j.1464-410X.2009.08990.x
Chade DC, Shariat SF, Cronin AM, Savage CJ, Karnes RJ, Blute ML et al (2011) Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. Eur Urol 60:205–210. https://doi.org/10.1016/j.eururo.2011.03.011
De Bari B, Fiorentino A, Arcangeli S, Franco P, D’Angelillo RM, Alongi F (2014) From radiobiology to technology: what is changing in radiotherapy for prostate cancer. Expert Rev Anticancer Ther 14(5):553–564. https://doi.org/10.1586/14737140.2014.883282
Mariucci C, Ingrosso G, Bini V, Saldi S, Lupattelli M, Frattegiani A, Perrucci E, Palumbo I, Falcinelli L, Centofanti G, Bellavita R, Aristei C (2020) Helical tomotherapy re-irradiation for patients affected by local radiorecurrent prostate cancer. Rep Pract Oncol Radiother 25(2):157–162. https://doi.org/10.1016/j.rpor.2020.01.005
Detti B, Bonomo P, Masi L, Doro R, Cipressi S, Iermano C, Bonucci I, Franceschini D, Di Brina L, Baki M, Simontacchi G, Meattini I, Carini M, Serni S, Nicita G, Livi L (2016) CyberKnife stereotactic radiotherapy for isolated recurrence in the prostatic bed. World J Urol 34(3):311–317. https://doi.org/10.1007/s00345-015-1613-5
Vavassori A, Jereczek-Fossa BA, Beltramo G, De Cicco L, Fariselli L, Bianchi LC, Possanzini M, Bergantin A, DeCobelli O, Orecchia R (2010) Image-guided robotic radiosurgery as salvage therapy for locally recurrent prostate cancer after external beam irradiation: retrospective feasibility study on six cases. Tumori 96(1):71–75
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 (2019) Reirradiation for isolated local recurrence of prostate cancer: Mono-institutional series of 64 patients treated with salvage stereotactic body radiotherapy (SBRT). Br J Radiol 92(1094):20180494. https://doi.org/10.1259/bjr.20180494
Fuller D, Wurzer J, Shirazi R, Bridge S, Law J, Crabtree T, Mardirossian G (2020) Retreatment for local recurrence of prostatic carcinoma after prior therapeutic irradiation: efficacy and toxicity of HDR-like SBRT. Int J Radiat Oncol Biol Phys 106(2):291–299. https://doi.org/10.1016/j.ijrobp.2019.10.014
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 (2015) Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer. Br J Radiol 88(1052):20150197. https://doi.org/10.1259/bjr.20150197
Arcangeli S, Gambardella P, Agolli L, Monaco A, Dognini J, Regine G, Donato V (2015) Stereotactic body radiation therapy salvage reirradiation of radiorecurrent prostatic carcinoma relapsed in the prostatic bed. Tumori 101(2):e57–e59. https://doi.org/10.5301/tj.5000251
Olivier J, Basson L, Puech P, Lacornerie T, Villers A, Wallet J, Lartigau E, Pasquier D (2019) Stereotactic re-irradiation for local recurrence in the prostatic bed after prostatectomy: preliminary results. Front Oncol 15(9):71. https://doi.org/10.3389/fonc.2019.00071
Ingrosso G, Becherini C, Lancia A, Caini S, Ost P, Francolini G, Høyer M, Bottero M, Bossi A, Zilli T, Scartoni D, Livi L, Santoni R, Giacomelli I, Detti B (2019) Nonsurgical salvage local therapies for radiorecurrent prostate cancer: a systematic review and meta-analysis. Eur Urol Oncol. https://doi.org/10.1016/j.euo.2018.12.011
Rigo M, Mazzola R, Napoli G, Giaj-Levra N, Figlia V, Nicosia L, Ricchetti F, Tomasini D, Bonù ML, Cuccia F, Bellorofonte C, Alongi F (2020) Post-HIFU locally relapsed prostate cancer: high-dose salvage radiotherapy guided by molecular imaging. Radiol Med. https://doi.org/10.1007/s11547-020-01148-4
Li R, Ravizzini GC, Gorin MA, Maurer T, Eiber M, Cooperberg MR, Alemozzaffar M, Tollefson MK, Delacroix SE, Chapin BF (2018) The use of PET/CT in prostate cancer. Prostate Cancer Prostatic Dis 21(1):4–21. https://doi.org/10.1038/s41391-017-0007-8
Shipley WU, Seiferheld W, Lukka HR, Major PP, Heney NM, Grignon DJ, Sartor O, Patel MP, Bahary JP, Zietman AL, Pisansky TM, Zeitzer KL, Lawton CA, Feng FY, Lovett RD, Balogh AG, Souhami L, Rosenthal SA, Kerlin KJ, Dignam JJ, Pugh SL, Sandler HM, Oncology NRGRTOG (2017) Radiation with or without antiandrogen therapy in recurrent prostate cancer. N Engl J Med 376(5):417–428. https://doi.org/10.1056/NEJMoa1607529
Alongi F, Mazzola R, Fiorentino A, Corradini S, Aiello D, Figlia V, Gregucci F, Ballario R, Cavalleri S, Ruggieri R (2019) Phase II study of accelerated Linac-based SBRT in five consecutive fractions for localized prostate cancer. Strahlenther Onkol 195(2):113–120. https://doi.org/10.1007/s00066-018-1338-7
Ramey SJ, Marshall DT (2013) Re-irradiation for salvage of prostate cancer failures after primary radiotherapy. World J Urol 31:1339–1345
Chatzikonstantinou G, Zamboglou N, Ro¨del C et al (2017) High-dose-rate brachytherapy as salvage modality for locally recurrent prostate cancer after definitive radiotherapy. Strahlenther Onkol 193:683–691
Zilli T, Benz E, Dipasquale G, Rouzaud M, Miralbell R (2016) Reirradiation of prostate cancer local failures after previous curative radiation therapy: long-term outcome and tolerance. Int J Radiat Oncol Biol Phys 96(2):318–322. https://doi.org/10.1016/j.ijrobp.2016.05.024
Rutenberg MS, Meister M, Amin PP, Hussain A, Naslund MJ, Kwok Y (2016) Salvage external beam radiotherapy for locally recurrent prostate cancer after definitive brachytherapy. Brachytherapy 15(6):722–729. https://doi.org/10.1016/j.brachy.2016.08.004
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 GA, Livi L (2018) Robotic stereotactic retreatment for biochemical control in previously irradiated patients affected by recurrent prostate cancer. Clin Oncol (R Coll Radiol) 30(2):93–100. https://doi.org/10.1016/j.clon.2017.11.007
Janoray G, Reynaud-Bougnoux A, Ruffier-Loubiere A et al (2016) Reirradiation stereotaxique robotisee de recidive locale de cancer de prostate apres radiotherapie externe: Resultats preliminaires. Cancer Radiother 20:275–281
Mbeutcha A, Chauveinc L, Bondiau PY et al (2017) Salvage prostate reirradiation using high-dose-rate brachytherapy or focal stereotactic body radiotherapy for local recurrence after definitive radiation therapy. Radiat Oncol 12:1–10
Pasquier D, Martinage G, Janoray G, Rojas DP, Zerini D, Goupy F, De Crevoisier R, Bogart E, Calais G, Toledano A, Chauveinc L, Scher N, Bondiau PY, Hannoun-Levi JM, Silva M, Meyer E, Nickers P, Lacornerie T, Jereczek-Fossa BA, Lartigau E (2019) Salvage stereotactic body radiation therapy for local prostate cancer recurrence after radiation therapy: a retrospective multicenter study of the GETUG. Int J Radiat Oncol Biol Phys 105(4):727–734. https://doi.org/10.1016/j.ijrobp.2019.07.012
D’Agostino GR, Di Brina L, Mancosu P, Franzese C, Iftode C, Franceschini D, Clerici E, Tozzi A, Navarria P, Scorsetti M (2019) Reirradiation of locally recurrent prostate cancer with volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys 104(3):614–621. https://doi.org/10.1016/j.ijrobp.2019.02.041
Triggiani L, Alongi F, Buglione M, Detti B, Santoni R, Bruni A, Maranzano E, Lohr F, D’Angelillo R, Magli A, Bonetta A, Mazzola R, Pasinetti N, Francolini G, Ingrosso G, Trippa F, Fersino S, Borghetti P, Ghirardelli P, Magrini SM (2017) Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study. Br J Cancer 116(12):1520–1525. https://doi.org/10.1038/bjc.2017.103
Nicosia L, Franzese C, Mazzola R, Franceschini D, Rigo M, D’agostino G, Corradini S, Alongi F, Scorsetti M (2020) Recurrence pattern of stereotactic body radiotherapy in oligometastatic prostate cancer: a multi-institutional analysis. Strahlenther Onkol 196(3):213–221. https://doi.org/10.1007/s00066-019-01523-9
Alongi F, Fersino S, Giaj Levra N, Mazzola R, Ricchetti F, Fiorentino A, Ruggieri R, Malfatti V, Cavalleri S, Salgarello M (2015) Impact of 18F-choline PET/CT in the decision-making strategy of treatment volumes in definitive prostate cancer volumetric modulated radiation therapy. Clin Nucl Med 40(11):e496–e500
Donaldson IA, Alonzi R, Barratt D, Barret E, Berge V, Bott S, Bottomley D, Eggener S, Ehdaie B, Emberton M, Hindley R, Leslie T, Miners A, McCartan N, Moore CM, Pinto P, Polascik TJ, Simmons L, van der Meulen J, Villers A, Willis S, Ahmed HU (2015) Focal therapy: patients, interventions, and outcomes—a report from a consensus meeting. Eur Urol 67(4):771–777. https://doi.org/10.1016/j.eururo.2014.09.018
Kaljouw E, Pieters BR, Kova’cs G et al (2016) A Delphi consensus study on salvage brachytherapy for prostate cancer relapse after radiotherapy, a Uro-GEC study. Radiother Oncol 118:122–130
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
F. Cuccia, L. Nicosia, R. Mazzola, V. Figlia, N. Giaj-Levra, F. Ricchetti, M. Rigo, C. Vitale, S. Corradini, R. Ruggieri, and F. Alongi declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Cuccia, F., Nicosia, L., Mazzola, R. et al. Linac-based SBRT as a feasible salvage option for local recurrences in previously irradiated prostate cancer. Strahlenther Onkol 196, 628–636 (2020). https://doi.org/10.1007/s00066-020-01628-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00066-020-01628-6