Janoray G, Reynaud-Bougnoux A, Ruffier-Loubière A, Bernadou G, Pointreau Y, Calais G
Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer Center, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Université François-Rabelais, 37000 Tours, France.
Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer Center, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Université François-Rabelais, 37000 Tours, France.
Cancer Radiother. 2016 Jun;20(4):275-81. doi: 10.1016/j.canrad.2016.03.005. Epub 2016 Jun 21.
Management of prostate cancer relapses after external-beam radiation therapy is still undefined. Re-irradiation schedules have been explored in different tumour sites. In this report, we present our preliminary experience of re-irradiation using stereotactic body radiotherapy for localized prostate cancer failure.
Between March 2011 and October 2014, robotic stereotactic body radiation therapy was administered to patients previously treated with external-beam radiation therapy to a median dose of 71.1Gy (range, 45-76.5Gy) and with biochemical failure corresponding to a local in-field recurrence of prostate cancer. Ten patients had recurrences after postoperative external-beam radiotherapy. Patients underwent a pelvic MRI to confirm the recurrence and a total body staging using a ((18)F)-fluorocholine PET/CT. The prescription dose consisted of five fractions of 7.25Gy to a total dose of 36.25Gy. Efficacy was evaluated based on biochemical response and toxicity was evaluated according to CTCAE v.4.0 questionnaires and International Prostate Symptom Score.
Twenty-one patients were treated and followed for a median time of 11.7 months (mean: 13.4 months; range: 2.5-46.5 months). Median time between the first external-beam radiation therapy of prostate cancer and the first day of CyberKnife(®) treatment was 111 months (range: 38-398 months). One-year biochemical recurrence-free survival rate was 83.3%, and only one in-field progression was reported. Two patients had a biochemical failure corresponding to metastatic progression without evidence of local recurrence. Treatment was well tolerated, with only one grade 2 acute genitourinary toxicity, no grade≥2 acute gastrointestinal or late toxicities were reported.
Stereotactic body re-irradiation therapy using CyberKnife(®) after failed external-beam radiation therapy showed favourable results in terms of in-field local and biochemical control. Toxicity was low and acceptable. Further prospective studies are needed to confirm these results to select patient and to evaluate the introduction of androgen-deprivation therapy.
外照射放疗后前列腺癌复发的管理仍不明确。不同肿瘤部位已探索了再照射方案。在本报告中，我们展示了使用立体定向体部放疗治疗局限性前列腺癌复发的初步经验。
2011年3月至2014年10月期间，对先前接受过外照射放疗、中位剂量为71.1Gy（范围45 - 76.5Gy）且生化失败对应前列腺癌局部野内复发的患者实施机器人立体定向体部放射治疗。10例患者术后外照射放疗后复发。患者接受盆腔MRI以确认复发，并使用（18）F - 氟胆碱PET/CT进行全身分期。处方剂量为5次分割，每次7.25Gy，总剂量36.25Gy。根据生化反应评估疗效，并根据CTCAE v.4.0问卷和国际前列腺症状评分评估毒性。
21例患者接受治疗并随访，中位时间为11.7个月（平均：13.4个月；范围：2.5 - 46.5个月）。前列腺癌首次外照射放疗与射波刀治疗首日之间的中位时间为111个月（范围：38 - 398个月）。1年生化无复发生存率为83.3%，仅报告1例野内进展。2例患者生化失败对应远处转移进展，无局部复发证据。治疗耐受性良好，仅1例2级急性泌尿生殖系统毒性，未报告≥2级急性胃肠道或晚期毒性。
外照射放疗失败后使用射波刀进行立体定向体部再照射治疗在野内局部和生化控制方面显示出良好结果。毒性低且可接受。需要进一步的前瞻性研究来证实这些结果，以选择患者并评估雄激素剥夺治疗的引入。
