Abstract
Stereotactic body radiotherapy is being investigated in nodal oligometastatic prostate cancer recurrences as an alternative to systemic treatment. This approach yields excellent in-field control and a low toxicity profile. In selected cases, this approach might also defer palliative androgen deprivation therapy. Background The purpose of the study was to evaluate the prostate serum antigen (PSA) response, local control, progression-free survival (PFS), and toxicity of stereotactic body radiotherapy (SBRT) for lymph node (LN) oligorecurrent prostate cancer. Patients and Methods Between May 2012 and October 2015, 124 lesions were treated in 94 patients with a median dose of 24 Gy in 3 fractions. Seventy patients were treated for a single lesion and 25 for > 1 lesion. In 34 patients androgen deprivation (AD) was combined with SBRT. We evaluated biochemical response according to PSA level every 3 months after SBRT: a 3-month PSA decrease from pre-SBRT PSA of more than 10% identified responder patients. In case of PSA level increase, imaging was performed to evaluate clinical progression. Toxicity was assessed every 6 to 9 months after SBRT. Results Median follow-up was 18.5 months. In 13 patients (14%) Grade 1 to 2 toxicity was reported without any Grade 3 to 4 toxicity. Biochemical response, stabilization, and progression were observed in 64 (68%), 10 (11%), and 20 (21%) of 94 evaluable patients. Clinical progression was observed in 31 patients (33%) after a median time of 8.1 months. In-field progression occurred in 12 lesions (9.7%). Two-year local control and PFS rates were 84% and 30%, respectively. Age older than 75 years correlated with better biochemical response rate. Age older than 75 years, concomitant AD administered up to 12 months, and pelvic LN involvement correlated with longer PFS. Conclusion SBRT is safe and offers good in-field control. At 2 years after SBRT, 1 of 3 patients is progression-free. Further investigation is warranted to identify patients who benefit most from SBRT and to define the optimal combination with AD.
| Original language | English |
|---|---|
| Pages (from-to) | e623-e632 |
| Journal | Clinical Genitourinary Cancer |
| Volume | 15 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Aug 1 2017 |
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Keywords
- Lymph node recurrence
- Oligometastases
- Recurrent prostate cancer
- Robotic stereotactic radiotherapy
- Salvage radioablation
ASJC Scopus subject areas
- Oncology
- Urology
Cite this
Salvage Stereotactic Body Radiotherapy for Isolated Lymph Node Recurrent Prostate Cancer : Single Institution Series of 94 Consecutive Patients and 124 Lymph Nodes. / Jereczek-Fossa, Barbara Alicja; Fanetti, Giuseppe; Fodor, Cristiana; Ciardo, Delia; Santoro, Luigi; Francia, Claudia Maria; Muto, Matteo; Surgo, Alessia; Zerini, Dario; Marvaso, Giulia; Timon, Giorgia; Romanelli, Paola; Rondi, Elena; Comi, Stefania; Cattani, Federica; Golino, Federica; Mazza, Stefano; Matei, Deliu Victor; Ferro, Matteo; Musi, Gennaro; Nolè, Franco; de Cobelli, Ottavio; Ost, Piet; Orecchia, Roberto.
In: Clinical Genitourinary Cancer, Vol. 15, No. 4, 01.08.2017, p. e623-e632.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Salvage Stereotactic Body Radiotherapy for Isolated Lymph Node Recurrent Prostate Cancer
T2 - Single Institution Series of 94 Consecutive Patients and 124 Lymph Nodes
AU - Jereczek-Fossa, Barbara Alicja
AU - Fanetti, Giuseppe
AU - Fodor, Cristiana
AU - Ciardo, Delia
AU - Santoro, Luigi
AU - Francia, Claudia Maria
AU - Muto, Matteo
AU - Surgo, Alessia
AU - Zerini, Dario
AU - Marvaso, Giulia
AU - Timon, Giorgia
AU - Romanelli, Paola
AU - Rondi, Elena
AU - Comi, Stefania
AU - Cattani, Federica
AU - Golino, Federica
AU - Mazza, Stefano
AU - Matei, Deliu Victor
AU - Ferro, Matteo
AU - Musi, Gennaro
AU - Nolè, Franco
AU - de Cobelli, Ottavio
AU - Ost, Piet
AU - Orecchia, Roberto
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Stereotactic body radiotherapy is being investigated in nodal oligometastatic prostate cancer recurrences as an alternative to systemic treatment. This approach yields excellent in-field control and a low toxicity profile. In selected cases, this approach might also defer palliative androgen deprivation therapy. Background The purpose of the study was to evaluate the prostate serum antigen (PSA) response, local control, progression-free survival (PFS), and toxicity of stereotactic body radiotherapy (SBRT) for lymph node (LN) oligorecurrent prostate cancer. Patients and Methods Between May 2012 and October 2015, 124 lesions were treated in 94 patients with a median dose of 24 Gy in 3 fractions. Seventy patients were treated for a single lesion and 25 for > 1 lesion. In 34 patients androgen deprivation (AD) was combined with SBRT. We evaluated biochemical response according to PSA level every 3 months after SBRT: a 3-month PSA decrease from pre-SBRT PSA of more than 10% identified responder patients. In case of PSA level increase, imaging was performed to evaluate clinical progression. Toxicity was assessed every 6 to 9 months after SBRT. Results Median follow-up was 18.5 months. In 13 patients (14%) Grade 1 to 2 toxicity was reported without any Grade 3 to 4 toxicity. Biochemical response, stabilization, and progression were observed in 64 (68%), 10 (11%), and 20 (21%) of 94 evaluable patients. Clinical progression was observed in 31 patients (33%) after a median time of 8.1 months. In-field progression occurred in 12 lesions (9.7%). Two-year local control and PFS rates were 84% and 30%, respectively. Age older than 75 years correlated with better biochemical response rate. Age older than 75 years, concomitant AD administered up to 12 months, and pelvic LN involvement correlated with longer PFS. Conclusion SBRT is safe and offers good in-field control. At 2 years after SBRT, 1 of 3 patients is progression-free. Further investigation is warranted to identify patients who benefit most from SBRT and to define the optimal combination with AD.
AB - Stereotactic body radiotherapy is being investigated in nodal oligometastatic prostate cancer recurrences as an alternative to systemic treatment. This approach yields excellent in-field control and a low toxicity profile. In selected cases, this approach might also defer palliative androgen deprivation therapy. Background The purpose of the study was to evaluate the prostate serum antigen (PSA) response, local control, progression-free survival (PFS), and toxicity of stereotactic body radiotherapy (SBRT) for lymph node (LN) oligorecurrent prostate cancer. Patients and Methods Between May 2012 and October 2015, 124 lesions were treated in 94 patients with a median dose of 24 Gy in 3 fractions. Seventy patients were treated for a single lesion and 25 for > 1 lesion. In 34 patients androgen deprivation (AD) was combined with SBRT. We evaluated biochemical response according to PSA level every 3 months after SBRT: a 3-month PSA decrease from pre-SBRT PSA of more than 10% identified responder patients. In case of PSA level increase, imaging was performed to evaluate clinical progression. Toxicity was assessed every 6 to 9 months after SBRT. Results Median follow-up was 18.5 months. In 13 patients (14%) Grade 1 to 2 toxicity was reported without any Grade 3 to 4 toxicity. Biochemical response, stabilization, and progression were observed in 64 (68%), 10 (11%), and 20 (21%) of 94 evaluable patients. Clinical progression was observed in 31 patients (33%) after a median time of 8.1 months. In-field progression occurred in 12 lesions (9.7%). Two-year local control and PFS rates were 84% and 30%, respectively. Age older than 75 years correlated with better biochemical response rate. Age older than 75 years, concomitant AD administered up to 12 months, and pelvic LN involvement correlated with longer PFS. Conclusion SBRT is safe and offers good in-field control. At 2 years after SBRT, 1 of 3 patients is progression-free. Further investigation is warranted to identify patients who benefit most from SBRT and to define the optimal combination with AD.
KW - Lymph node recurrence
KW - Oligometastases
KW - Recurrent prostate cancer
KW - Robotic stereotactic radiotherapy
KW - Salvage radioablation
UR - http://www.scopus.com/inward/record.url?scp=85011585975&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85011585975&partnerID=8YFLogxK
U2 - 10.1016/j.clgc.2017.01.004
DO - 10.1016/j.clgc.2017.01.004
M3 - Article
VL - 15
SP - e623-e632
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
SN - 1558-7673
IS - 4
ER -