Ozyigit G, Hurmuz P, Akinci D, Esen S C B, Yilmaz M T, Akdogan B, Akyol F H
Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Cancer Radiother. 2020 Dec;24(8):805-811. doi: 10.1016/j.canrad.2020.03.009. Epub 2020 Jun 18.
The optimal management of locally recurrent prostate cancer after curative radiotherapy is still unknown. In this study, we evaluated the preliminary results of reirradiation using stereotactic body radiotherapy for locally recurrent prostate cancer after initial definitive local radiotherapy.
Between April 2016 and February 2019, 11 patients with recurrent disease at the previously irradiated prostate were treated. Local recurrence was detected by radiological with or without functional imaging modalities including prostate multiparametric/pelvic MRI or positron-emission tomography-computerised tomography with (Ga)-labelled prostate-specific membrane antigen performed after rising prostate specific antigen serum level during follow-up. All patients received stereotactic body radiotherapy to the recurrent nodule to a total dose of 30Gy in five fractions. Hyaluronic acid spacer was injected between prostate and rectum in seven patients to decrease the rectal dose. Acute toxicity was evaluated by using Common Terminology Criteria for Adverse Events version 4.0, and late toxicity was evaluated by using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema.
At the diagnosis, the median age was 64 years, and the mean prostate specific antigen serum concentration was 17.7ng/mL. The median interval time between local recurrence and initial definitive radiotherapy was 63 months. Mean prostate specific antigen concentration nadir value during follow-up was 0.43ng/mL. With a median follow up of 19 months, three patients developed either local or distant relapse. One patient had grade 3 acute rectal toxicity, and one patient had grade 2 late urinary toxicity. We did not observe any acute or late toxicity due to hyaluronic acid spacer injection.
Reirradiation after local recurrence following initial definitive radiotherapy together with hyaluronic acid spacer use seems to be effective and safe.
根治性放疗后局部复发性前列腺癌的最佳治疗方案仍不明确。在本研究中，我们评估了使用立体定向体部放疗对初始确定性局部放疗后局部复发性前列腺癌进行再照射的初步结果。
2016年4月至2019年2月，对11例先前接受过放疗的前列腺复发患者进行了治疗。通过影像学检查（有或无功能成像模式，包括前列腺多参数/盆腔MRI或在随访期间前列腺特异性抗原血清水平升高后进行的（Ga）标记前列腺特异性膜抗原正电子发射断层扫描-计算机断层扫描）检测局部复发。所有患者均接受对复发结节的立体定向体部放疗，总剂量为30Gy，分5次给予。7例患者在前列腺和直肠之间注射透明质酸间隔物以降低直肠剂量。使用不良事件通用术语标准4.0评估急性毒性，使用放射治疗肿瘤学组/欧洲癌症研究与治疗组织晚期放射发病率评分方案评估晚期毒性。
诊断时，中位年龄为64岁，平均前列腺特异性抗原血清浓度为17.7ng/mL。局部复发与初始确定性放疗之间的中位间隔时间为63个月。随访期间前列腺特异性抗原浓度的平均最低点值为0.43ng/mL。中位随访19个月，3例患者出现局部或远处复发。1例患者出现3级急性直肠毒性，1例患者出现2级晚期泌尿系统毒性。我们未观察到因注射透明质酸间隔物导致的任何急性或晚期毒性。
初始确定性放疗后局部复发后的再照射联合使用透明质酸间隔物似乎有效且安全。
