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Prostatectomy Bed Image-guided Dose-escalated Salvage Radiotherapy (SPIDER): An International Multicenter

Nicolas Benziane-Ouaritini1, Thomas Zilli2, Antoine Giraud1

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European Urology Oncology
|April 14, 2023
PubMed
Summary
This summary is machine-generated.

Salvage radiotherapy (SRT) shows promise for managing macroscopic local recurrence (MLR) after prostatectomy. Dose escalation to at least 72 Gy may improve progression-free survival with acceptable toxicity.

Keywords:
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Area of Science:

  • Oncology
  • Radiation Oncology
  • Urologic Oncology

Background:

  • Management of macroscopic local recurrence (MLR) after radical prostatectomy (RP) lacks standardized approaches.
  • Functional imaging is crucial for identifying MLR in the prostate bed for targeted treatment.

Purpose of the Study:

  • To assess the efficacy and safety of functional image-guided salvage radiotherapy (SRT) for MLR in the prostate bed.
  • To evaluate the impact of dose escalation on treatment outcomes.

Main Methods:

  • Retrospective analysis of 310 patients across 16 European centers treated with SRT for MLR after RP.
  • Inclusion criteria: PSA relapse, MLR visualized on functional imaging, no distant metastasis.
  • Primary endpoint: Progression-free survival (PFS); Secondary endpoints: metastasis-free survival, toxicity (GU/GI).

Main Results:

  • Five-year PFS was 70% and metastasis-free survival was 84%.
  • Grade ≥2 genitourinary (GU) and gastrointestinal (GI) toxicities occurred in 12% and 3% of patients, respectively.
  • Dose escalation to ≥72 Gy on MLR significantly improved 5-year PFS (73% vs. 60%, p=0.03).

Conclusions:

  • Functional image-guided SRT with dose escalation (≥72 Gy) shows potential efficacy for MLR in the prostate bed.
  • The treatment demonstrated an acceptable toxicity profile.
  • Prospective studies are needed to confirm these findings for SRT dose escalation strategies.