Salvage Stereotactic Body Radiotherapy for Isolated Lymph Node Recurrent Prostate Cancer

Single Institution Series of 94 Consecutive Patients and 124 Lymph Nodes

Barbara Alicja Jereczek-Fossa, Giuseppe Fanetti, Cristiana Fodor, Delia Ciardo, Luigi Santoro, Claudia Maria Francia, Matteo Muto, Alessia Surgo, Dario Zerini, Giulia Marvaso, Giorgia Timon, Paola Romanelli, Elena Rondi, Stefania Comi, Federica Cattani, Federica Golino, Stefano Mazza, Deliu Victor Matei, Matteo Ferro, Gennaro Musi & 4 others Franco Nolè, Ottavio de Cobelli, Piet Ost, Roberto Orecchia

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16 Citations (Scopus)

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 languageEnglish
Pages (from-to)e623-e632
JournalClinical Genitourinary Cancer
Volume15
Issue number4
DOIs
Publication statusPublished - Aug 1 2017

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Radiosurgery
Prostatic Neoplasms
Lymph Nodes
Prostate
Androgens
Antigens
Disease-Free Survival
Serum
Survival Rate
Recurrence

Keywords

  • Lymph node recurrence
  • Oligometastases
  • Recurrent prostate cancer
  • Robotic stereotactic radiotherapy
  • Salvage radioablation

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{9c27fbd2b81f433885ec91250fa43bdf,
title = "Salvage Stereotactic Body Radiotherapy for Isolated Lymph Node Recurrent Prostate Cancer: Single Institution Series of 94 Consecutive Patients and 124 Lymph Nodes",
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.",
keywords = "Lymph node recurrence, Oligometastases, Recurrent prostate cancer, Robotic stereotactic radiotherapy, Salvage radioablation",
author = "Jereczek-Fossa, {Barbara Alicja} and Giuseppe Fanetti and Cristiana Fodor and Delia Ciardo and Luigi Santoro and Francia, {Claudia Maria} and Matteo Muto and Alessia Surgo and Dario Zerini and Giulia Marvaso and Giorgia Timon and Paola Romanelli and Elena Rondi and Stefania Comi and Federica Cattani and Federica Golino and Stefano Mazza and Matei, {Deliu Victor} and Matteo Ferro and Gennaro Musi and Franco Nol{\`e} and {de Cobelli}, Ottavio and Piet Ost and Roberto Orecchia",
year = "2017",
month = "8",
day = "1",
doi = "10.1016/j.clgc.2017.01.004",
language = "English",
volume = "15",
pages = "e623--e632",
journal = "Clinical Genitourinary Cancer",
issn = "1558-7673",
publisher = "Elsevier Inc.",
number = "4",

}

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

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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 -