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Robotic Stereotactic Retreatment for Biochemical Control in Previously Irradiated Patients Affected by Recurrent
M Loi1, V Di Cataldo2, G Simontacchi1
1Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|December 7, 2017
Summary
Robotic stereotactic body radiotherapy (rSBRT) effectively treats localized prostate cancer recurrence after prior radiation. Patient selection is crucial for durable remission and postponing systemic therapy with acceptable toxicity.
Area of Science:
- Oncology
- Radiation Oncology
- Urologic Oncology
Background:
- Local recurrence of prostate cancer after initial radiation therapy presents a treatment challenge.
- Robotic stereotactic body radiotherapy (rSBRT) is an emerging option for managing these recurrences.
Purpose of the Study:
- To evaluate the efficacy and safety of CyberKnife rSBRT for locally recurrent prostate cancer after prior radiation therapy.
- To assess biochemical relapse-free survival (BRFS) and toxicity in this patient cohort.
Main Methods:
- Retrospective review of 50 patients with locally recurrent prostate cancer post-radiotherapy.
- rSBRT delivered at 30 Gy in five fractions, with recurrence assessed by imaging (18F-choline PET, MRI).
- Prostate-specific antigen (PSA) and toxicity (CTCAE v.4.03) were monitored post-treatment.
Main Results:
- 80.0% biochemical relapse-free survival (BRFS) at 6 months.
- Median PSA decline of -77.1% in 41 patients; PSA elevation in nine patients.
- High-risk diagnosis and ongoing androgen deprivation were correlated with impaired BRFS.
Conclusions:
- Focal rSBRT can achieve durable remission in patients with locally relapsing prostate cancer.
- Systemic treatment can be postponed, with acceptable toxicity, emphasizing the need for accurate patient selection.
