Olivier Jonathan, Basson Laurent, Puech Philippe, Lacornerie Thomas, Villers Arnauld, Wallet Jennifer, Lartigau Eric, Pasquier David
Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.
Department of Urology, CHU Lille, Lille, France.
Front Oncol. 2019 Feb 15;9:71. doi: 10.3389/fonc.2019.00071. eCollection 2019.
To report the preliminary results of salvage re-irradiation in the prostatic bed after radical prostatectomy and salvage external beam radiation therapy (EBRT) using robotic stereotactic body radiation therapy (SBRT) with Cyberknife® for local recurrence of prostate cancer. Retrospective monocentric analysis was performed on patients treated with SBRT for isolated macroscopic recurrence in the prostatic bed. All patients had radical prostatectomy and salvage or adjuvant EBRT. Local recurrence was documented using magnetic resonance imaging (MRI) and positron emission tomography (PET). Biochemical recurrence was defined as 2 rises in prostate-specific antigen (PSA) of ≥ 0.2 ng/mL above nadir. Internal gold fiducials were used for the tracking of tumor motion during SBRT. The prescription dose was 36 Gy in 6 fractions for all patients. Toxicity was scored according to the CTCAE v4.0. Between July 2011 and November 2017, 12 patients were treated with SBRT for prostatic bed recurrence with a median follow-up of 34.2 (range, 3.5-64.4) months. Isolated non-metastatic recurrence in the prostatic bed was seen at MRI and PET imaging. Two patients were treated with 6 months androgen deprivation therapy (ADT) concomitant with re-irradiation. The median planning target volume was 4.5 cm (range, 1.2-13.3). A PSA decrease after SBRT was found in 10 (83%) patients. The 1 and 2 years biochemical recurrence-free survival rates were 79 and 56%, respectively. Biochemical recurrence was observed for 6 patients (50%) after a median time of 18 (4-42) months. Toxicity showed: 3 patients (25%) with grade 1 cystitis and 1 patient (8%) with acute grade 2 proctitis at 4 months. One patient (13%) had grade 1 cystitis at 12 months. Re-irradiation for local recurrence in the prostatic bed using Cyberknife® after surgery and salvage or adjuvant EBRT is well-tolerated and associated with 2 years biochemical recurrence-free survival rates of 56%. Longer follow-up and larger series are necessary.
报告在根治性前列腺切除术后前列腺床挽救性再照射以及使用射波刀®机器人立体定向体部放射治疗（SBRT）进行挽救性外照射放疗（EBRT）治疗前列腺癌局部复发的初步结果。对因前列腺床孤立性肉眼复发接受SBRT治疗的患者进行回顾性单中心分析。所有患者均接受了根治性前列腺切除术以及挽救性或辅助性EBRT。使用磁共振成像（MRI）和正电子发射断层扫描（PET）记录局部复发情况。生化复发定义为前列腺特异性抗原（PSA）较最低点升高2次且每次升高≥0.2 ng/mL。在SBRT期间使用内部金标来追踪肿瘤运动。所有患者的处方剂量均为36 Gy，分6次给予。根据美国国立癌症研究所不良事件通用术语标准第4.0版（CTCAE v4.0）对毒性进行评分。2011年7月至2017年11月期间，12例患者因前列腺床复发接受了SBRT治疗，中位随访时间为34.2（范围3.5 - 64.4）个月。MRI和PET成像显示前列腺床存在孤立性非转移性复发。2例患者在再照射的同时接受了6个月的雄激素剥夺治疗（ADT）。中位计划靶体积为4.5 cm（范围1.2 - 13.3）。10例（83%）患者在SBRT后PSA下降。1年和2年无生化复发生存率分别为79%和56%。6例患者（50%）在中位时间18（4 - 42）个月后出现生化复发。毒性表现为：3例患者（25%）在4个月时出现1级膀胱炎，1例患者（8%）在4个月时出现急性2级直肠炎。1例患者（13%）在12个月时出现1级膀胱炎。手术后以及挽救性或辅助性EBRT后使用射波刀®对前列腺床局部复发进行再照射耐受性良好，2年无生化复发生存率为56%。需要更长时间的随访和更大规模的数据系列。
