Salvage Stereotactic Reirradiation for Local Recurrence in the Prostatic Bed After Prostatectomy: A Retrospective Multicenter Study.

Male Humans Re-Irradiation Retrospective Studies Neoplasm Recurrence, Local / radiotherapy Prostatic Neoplasms / radiotherapy Prostatectomy / adverse effects

Prostate cancer Prostatic bed Radical prostatectomy Recurrence Reirradiation Salvage stereotactic radiation therapy

Journal

European urology oncology

ISSN: 2588-9311

Titre abrégé: Eur Urol Oncol

Pays: Netherlands

ID NLM: 101724904

Informations de publication

Date de publication:
Jun 2023

Historique:

received: 25 07 2022

revised: 01 03 2023

accepted: 11 03 2023

medline: 19 6 2023

pubmed: 4 4 2023

entrez: 3 4 2023

Statut: ppublish

Résumé

Management of local recurrence of prostate cancer (PCa) in the prostatic bed after radical prostatectomy (RP) and radiotherapy remains challenging. To assess the efficacy and safety of salvage stereotactic body radiotherapy (SBRT) reirradiation in this setting and evaluate prognostic factors. We conducted a large multicenter retrospective series that included 117 patients who were treated with salvage SBRT for local recurrence in the prostatic bed after RP and radiotherapy in 11 centers across three countries. Progression-free survival (PFS; biochemical, clinical, or both) was estimated using the Kaplan-Meier method. Biochemical recurrence was defined as prostate-specific antigen nadir +0.2 ng/ml, confirmed by a second increasing measure. The cumulative incidence of late toxicities was estimated using the Kalbfleisch-Prentice method by considering recurrence or death as a competing event. The median follow-up was 19.5 mo. The median SBRT dose was 35 Gy. The median PFS was 23.5 mo (95% confidence interval [95% CI], 17.6-33.2). In the multivariable models, the volume of the recurrence and its contact with the urethrovesical anastomosis were significantly associated with PFS (hazard ratio [HR]/10 cm Salvage SBRT for local recurrence in the prostate bed may offer encouraging control and acceptable toxicity. Therefore, further prospective studies are warranted. We found that salvage stereotactic body radiotherapy after surgery and radiotherapy allows for encouraging control and acceptable toxicity in locally relapsed prostate cancer.

Sections du résumé

BACKGROUND BACKGROUND

Management of local recurrence of prostate cancer (PCa) in the prostatic bed after radical prostatectomy (RP) and radiotherapy remains challenging.

OBJECTIVE OBJECTIVE

To assess the efficacy and safety of salvage stereotactic body radiotherapy (SBRT) reirradiation in this setting and evaluate prognostic factors.

DESIGN, SETTING, AND PARTICIPANTS METHODS

We conducted a large multicenter retrospective series that included 117 patients who were treated with salvage SBRT for local recurrence in the prostatic bed after RP and radiotherapy in 11 centers across three countries.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS METHODS

Progression-free survival (PFS; biochemical, clinical, or both) was estimated using the Kaplan-Meier method. Biochemical recurrence was defined as prostate-specific antigen nadir +0.2 ng/ml, confirmed by a second increasing measure. The cumulative incidence of late toxicities was estimated using the Kalbfleisch-Prentice method by considering recurrence or death as a competing event.

RESULTS AND LIMITATIONS CONCLUSIONS

The median follow-up was 19.5 mo. The median SBRT dose was 35 Gy. The median PFS was 23.5 mo (95% confidence interval [95% CI], 17.6-33.2). In the multivariable models, the volume of the recurrence and its contact with the urethrovesical anastomosis were significantly associated with PFS (hazard ratio [HR]/10 cm

CONCLUSIONS CONCLUSIONS

Salvage SBRT for local recurrence in the prostate bed may offer encouraging control and acceptable toxicity. Therefore, further prospective studies are warranted.

PATIENT SUMMARY RESULTS

We found that salvage stereotactic body radiotherapy after surgery and radiotherapy allows for encouraging control and acceptable toxicity in locally relapsed prostate cancer.

Identifiants

DOI: 10.1016/j.euo.2023.03.005 PMID: 37012102

pubmed: 37012102

pii: S2588-9311(23)00070-6

doi: 10.1016/j.euo.2023.03.005

pii:

doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

303-310