Re-irradiation of prostate cancer local failures after previous curative radiotherapy: long-term outcome and tolerance

Publication date: Available online 28 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Thomas Zilli, Eileen Benz, Giovanna Dipasquale, Michel Rouzaud, Raymond Miralbell
Purpose/ObjectiveTo evaluate safety, feasibility, side-effect profile, and proof of concept of external beam radiotherapy (EBRT) with or without a brachytherapy (BT) boost for salvage of exclusive local failure after primary EBRT for prostate cancer.Materials and MethodsFourteen patients with presumed exclusive local recurrence after primary EBRT with or without BT were considered eligible for re-irradiation. The median normalized total dose in 2 Gy-fractions (NTD2Gy, α/β ratio=1.5 Gy) was 74 Gy (66-98.4) at 1^st irradiation. Median time between the 1^st RT and the re-irradiation was 6.1 years (range, 4.7-10.2).ResultsBetween 2003 and 2008 salvage treatment was delivered with a median NTD2Gy of 85.1 Gy (70-93.4) to the prostate with EBRT with (n=10) or without (n=4) BT. Androgen deprivation was given to 12 patients (median time of 12 months). No Grade ≥ 3 toxicity was observed during and within 6 weeks after RT. After a median follow-up of 94 months (range, 48-172) post-salvage RT, 5-year Grade ≥3 GU and GI toxicity-free survival figures were 77.9±11.3% and 57.1±13.2%, respectively. Four patients presented with combined Grade 4 GU/GI toxicity. The 5-year biochemical relapse-free, local relapse-free, distant metastasis-free and cancer-specific survivals were 35.7±12.8%, 50.0±13.4%, 85.7±9.4%, and 100%, respectively.ConclusionSalvage whole gland re-irradiation for patients with a suspicious of exclusive local recurrence after initial RT may be associated with a high rate of severe radiation-induced side-effects and a poor long-term biochemical and local control.

Teaser

In this retrospective study we evaluated the long-term results of fourteen prostate cancer patients treated with salvage external beam radiotherapy (EBRT) for exclusive local failure after primary EBRT. Whole gland re-irradiation resulted in a high rate of severe radiation-induced side-effects and a poor long-term biochemical and local control. Alternative salvage re-irradiation modalities should be explored for selected cases of local relapse in accurately designed prospective trials.


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