Abstract
Purpose
To report a clinical experience in stereotactic body radiation therapy (SBRT) for isolated nodal metastases from prostate cancer.
Materials and methods
Between November 2011 and December 2013, 30 patients (39 lesions) were treated with SBRT, delivered using Cyberknife, for recurrent prostate cancer with isolated nodal metastases. Prescribed doses and schedules of fractionation varied, ranging from 24 Gy in 1 fraction to 36 Gy in 3 fractions. Most commonly used schedules were 30 Gy in 3 fractions and 36 in Gy in 3 fractions on alternating days. Biochemical response, acute and late toxicity were analyzed.
Results
At a median follow-up of 12 months (range 2–24.9), a significant reduction of PSA was observed in 24 cases, while PSA was stable in 1 case and raised in 9 cases. At the time of analysis, among the 30 patients treated, two were dead for systemic disease; 12 patients experienced a relapse of disease in other sites. Sixteen patients were still free of disease. In 24 cases, imaging evaluation 3 months after treatment was available. No in-field recurrence was detected. SBRT was well tolerated: One patient experienced G2 acute genitourinary toxicity. Late toxicity was evaluated in patients with more than 6 months of follow-up, and only one complained G1 proctitis. We did not observe any acute or late severe toxicity (≥G3).
Conclusions
Our experience shows that SBRT for isolated nodal relapse from prostate cancer is a safe treatment, with promising results in terms of efficacy.
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References
Gronau E, Goppelt M, Harzmann R et al (2005) Prostate cancer relapse after therapy with curative intention: a diagnostic and therapeutic dilemma. Onkologie 28:361–366
Mottet N, Bellmunt J, Bolla M et al (2011) EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing and castration-resistant prostate cancer. Eur Urol 59(4):572–583
Smith DP, King MT, Egger S et al (2009) Quality of life three years after diagnosis of localized prostate cancer: population based cohort study. BMJ 339:b4817
Tsujimura A (2013) Role of androgen in the elderly. Problems of androgen deprivation therapy. Clin Calcium 23(8):1185–1190
Hamberg P, Verhagen PC, de Wit R (2008) When to start cytotoxic therapy in asymptomatic patients with hormone refractory prostate cancer? Eur J Cancer 44:1193–1197
Niibe Y, Chang JY (2012) Novel insights of oligometastases and oligorecurrence and review of literature. Pulm Med 2012:261096
Alongi F, Arcangeli S, Filippi AR et al (2012) Review and uses of stereotactic body radiation therapy for oligometastases. Oncologist 17(8):1100–1107
Chambers AF, Groom AC, MacDonald IC (2003) Dissemination and growth of cancer cells in metastatic sites. Nat Rev Cancer 3(6):453–458
Leborgne F, Fowler J, Leborgne JH et al (2012) Later outcomes and alpha/beta ratio estimate from hypofractionated conformal three dimensional radiotherapy versus standard fractionation for localized prostate cancer. Int J Radiat Oncol Biol Phys 82:1200–1207
Sharifi N, Gulley JL, Dahut WL (2005) Androgen deprivation therapy for prostate cancer. JAMA 294:238–244
Engels B, Soete G, Tournel K et al (2009) Helical tomotherapy with simultaneous integrated boost for high-risk and lymph node-positive prostate cancer. Technol Cancer Res Treat 8(5):353–359
Alongi F, Schipani S, Samanes Gajate AM et al (2010) [11C]choline-PET-guided helical tomotherapy and estramustine in a patient with pelvic-recurrent prostate cancer: local control and toxicity profile after 24 months. Tumori 96(4):613–617
Ricchetti F, Barra S, Agostinelli S, Vagge S, Marcenaro M, Corvò R (2011) Feasibility of helical tomotherapy for radical dose retreatment in pelvic area: a report of 4 cases. Tumori 97(4):492–497
Scorsetti M, Bignardi M, Alongi F et al (2011) Stereotactic body radiation therapy for abdominal targets using volumetric intensity modulated arc therapy with RapidArc: feasibility and clinical preliminary results. Acta Oncol 50:528–538
Jereczec-Fossa BA, Fariselli L, Beltramo G et al (2009) Linac-based or robotic image-guided stereotactic radiotherapy for isolated lymph node recurrent prostate cancer. Radiother Oncol 93:14–17
Jereczec-Fossa BA, Beltramo G, Fariselli L et al (2012) Robotic image-guided stereotactic radiotherapy for isolated recurrent primary, lymph node or metastatic prostate cancer. Int J Radiat Oncol Biol Phys 82:889–897
Brenner DJ, Hall EJ (1999) Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys 43(5):1095–1101
Katz AJ, Santoro M, Ashley R, Diblasio F (2011) Stereotactic body radiation therapy for low- and low intermediate-risk prostate cancer: is there a dose effect? Front Oncol 1:49
Koh DH, Kim JB, Kim HW, Chang YS, Kim HJ (2014) Clinical outcomes of CyberKnife radiotherapy in prostate cancer patients: short-term, single-center experience. Korean J Urol 55(3):172–177
Engels B, Everaert H, Gevaert T et al (2011) Phase II study of helical tomotherapy for oligometastatic colorectal cancer. Ann Oncol 22:362–368
Engels B, Gevaert T, Everaert H et al (2012) Phase II study of helical tomotherapy in the multidisciplinary treatment of oligometastatic colorectal cancer. Radiat Oncol 7:34
Corbin KS, Hellman S, Weichselbaum RR (2013) Extracranial oligometastases: a subset of metastases curable with stereotactic radiotherapy. J Clin Oncol 31:1384–1390
de Vin T, Engels B, Gevaert T, Storme G, De Ridder M (2014) Stereotactic radiotherapy for oligometastatic cancer: a prognostic model for survival. Ann Oncol 25(2):467–471
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Detti, B., Bonomo, P., Masi, L. et al. Stereotactic radiotherapy for isolated nodal recurrence of prostate cancer. World J Urol 33, 1197–1203 (2015). https://doi.org/10.1007/s00345-014-1427-x
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DOI: https://doi.org/10.1007/s00345-014-1427-x