Macroscopic locoregional relapse from prostate cancer: which role for salvage radiotherapy?
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Salvage radiotherapy (SRT) after radical prostatectomy for prostate cancer (PCa) is recommended as soon as PSA rises above 0.20 ng/ml, but many patients (pts) still experience local macroscopic relapse. The aim of this multicentric retrospective analysis was to evaluate the role of SRT in pts with macroscopic relapse.
Materials and methods
From 2001 to 2016, 105 consecutive pts with macroscopic PCa relapse underwent SRT ± androgen deprivation therapy (ADT). Mean age was 72 years. At time of relapse, 29 pts had a PSA value < 1.0 ng/mL, 50 from 1.1 to 5, and 25 pts > 5. Before SRT, 23 pts had undergone 18F-choline PET and 15 pts pelvic MRI. Ninety-four pts had prostatic bed relapse only, and four nodal involvement. Fifty-one pts were previously submitted to first-line ADT, while 6 pts received ≥ 2 lines.
At a median follow-up of 52 months, 89 pts were alive, while 16 were dead. Total RT dose to macroscopic lesions was > 70 Gy in 58 pts, 66–70 Gy in 43, and < 66 Gy in 4 pts. In 72 pts, target volume encompassed only the prostatic bed with sequential boost to macroscopic site; 33 pts received prophylactic pelvic RT. Ten-year overall survival was 76.1%, while distant metastasis-free survival was 73.3%. No grade 4–5 toxicities were found.
SRT ± ADT for macroscopic relapse showed a favorable oncological outcome supporting its important role in this scenario. Data from this series suggest that SRT may either postpone ADT or improve results over ADT alone in appropriately selected pts.
KeywordsHormone therapy Macroscopic relapse Prostate cancer Salvage radiotherapy Toxicities
No funding was foreseen to sustain this work
Compliance with ethical standards
Conflict of interest
Alessio Bruni was member of an Advisory Board for Astra Zeneca receiving a Grant. He also received a sponsorship from Ferring, Janssen and Astellas to participate to National and International Conference. He also received a speaker honorarium from Astra Zeneca. Gianluca Ingrosso declares he has no conflict of interests. Fabio Trippa declares he has no conflict of interests, Mario Di Staso declares he has no conflict of interests, Biancaluisa Lanfranchi declares he has no conflict of interests. Laura Rubino declares he has no conflict of interests; Silvia Parente declares he has no conflict of interest. Luca Frassinelli declares he has no conflict of interests. Ernesto Maranzano declares he has no conflict of interests. Riccardo Santoni declares he has no conflict of interests. Maria Chiara Sighinolfi declares he has no conflict of interests. Frank Lohr declares he has no conflict of interests. Ercole Mazzeo received an honorarium as expert from Janssen.
All procedures performed in the study were in accordance with the ethical standards of the Institutional and National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent for the treatment proposed was obtained from all individual participants included in the study.
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