Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland.
III Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-100, Gliwice, Poland.
Strahlenther Onkol. 2024 Mar;200(3):230-238. doi: 10.1007/s00066-023-02187-2. Epub 2023 Dec 29.
Local recurrences after radical prostatectomy (RP) and postoperative radiotherapy (RT) are challenging for salvage treatment. Retrospective analysis of own experiences with salvage re-irradiation was performed.
The study included all consecutive patients treated with salvage stereotactic body radiotherapy (sSBRT) for prostate bed recurrence following RP and postoperative RT at a single tertiary center between 2014 and 2021. Treatment toxicity defined as the occurrence of CTCAE grade ≥ 2 genito-urinary (GU) or gastro-intestinal (GI) adverse events (AEs) was assessed. A PSA response, biochemical control (BC) and overall survival (OS) were also evaluated.
The study group included 32 patients with a median age of 68 years and a median follow-up of 41 months, treated with CyberKnife (53%) or Linac (47%) sSBRT. Total dose of 33.75-36.25 Gy in five fractions (72%) was applied in the majority of them. Approximately 19% patients reported grade ≥ 2 GU AEs both at baseline and at three months, and grade ≥ 2 GI toxicity increased from 0% at baseline to 6% at three months after sSBRT. There was some clinically relevant increase in late toxicity with 31% patients reporting late ≥ 2 GU, and 12.5% late ≥ 2 GI AEs. Two grade 3 AEs were recorded: recto-urinary fistulas. The majority of patients showed a PSA response (91% at one year post-sSBRT). The 3‑year BC was 40% and 3‑year OS was 87%.
Manageable toxicity profile and satisfactory biochemical response suggest that SBRT in patients with local recurrence following RP and postoperative RT might be a salvage option for selected patients.
根治性前列腺切除术（RP）和术后放疗（RT）后的局部复发对挽救治疗是一个挑战。对自身行挽救性再放疗的经验进行了回顾性分析。
该研究纳入了 2014 年至 2021 年期间在一家三级中心因 RP 和术后 RT 后前列腺床复发而行挽救性立体定向体部放疗（sSBRT）的所有连续患者。将定义为 CTCAE 分级≥2 级泌尿生殖（GU）或胃肠（GI）不良事件（AE）的治疗毒性进行评估。还评估了 PSA 反应、生化控制（BC）和总生存（OS）。
该研究组包括 32 名中位年龄为 68 岁、中位随访时间为 41 个月的患者，采用 CyberKnife（53%）或 Linac（47%）sSBRT 治疗。大多数患者接受 33.75-36.25Gy 的 5 个分次剂量。约 19%的患者在基线和 3 个月时报告有≥2 级 GUAE，而基线时无 GI 毒性，在 sSBRT 后 3 个月时增至 6%。晚期毒性有一定的临床相关增加，31%的患者报告有晚期≥2 级 GUAE，12.5%的患者报告有晚期≥2 级 GIAE。记录到 2 例 3 级 AE：直肠-尿路瘘。大多数患者表现出 PSA 反应（sSBRT 后 1 年时 91%）。3 年 BC 为 40%，3 年 OS 为 87%。
可管理的毒性谱和令人满意的生化反应表明，对于 RP 和术后 RT 后局部复发的患者，SBRT 可能是一种可供选择的挽救治疗方法。
