World Journal of Urology

, Volume 34, Issue 3, pp 311–317 | Cite as

CyberKnife stereotactic radiotherapy for isolated recurrence in the prostatic bed

  • B. Detti
  • P. Bonomo
  • L. Masi
  • R. Doro
  • S. Cipressi
  • C. Iermano
  • I. Bonucci
  • D. Franceschini
  • L. Di Brina
  • M. Baki
  • G. Simontacchi
  • I. Meattini
  • M. Carini
  • S. Serni
  • G. Nicita
  • L. Livi
Original Article

Abstract

Purpose

To report a clinical experience of stereotactic body radiation therapy (SBRT) for isolated recurrence in the prostatic bed from prostate cancer.

Materials and methods

Between November 2011 and November 2013, 16 patients were treated with SBRT for a macroscopic isolated recurrence of prostate cancer in the prostatic bed. All patients were initially treated with radical prostatectomy, and half of them also received radiotherapy. Two schedules of SBRT were used: 30 Gy in 5 fractions in previously irradiated patients, 35 Gy in five fractions in radiotherapy-naïve patients.

Results

At a median follow-up of 10 months (range 2–21 months), a significant biochemical response was found in all but one patient. At imaging evaluation, no local progression was noted: 10 patients showed partial response while four stable disease. At the moment of analysis, all 16 patients were alive. Seven of them experienced distant relapse, while nine maintained biochemical control, with no further therapy. Median time to relapse was 9.3 months (range 3–15.2 months). The treatment was well tolerated: One patient experienced G2 acute genitourinary and gastrointestinal toxicity.

Conclusions

Our experience shows that SBRT with CyberKnife for isolated nodal relapse is a safe and well-tolerated treatment.

Keywords

Prostate cancer Stereotactic radiotherapy CyberKnife Local control Relapse 

References

  1. 1.
    Hagan M, Zlotecki R, Medina C, Tercilla O, Rivera I, Wajsman Z (2004) Comparison of adjuvant versus salvage radiotherapy policies for postprostatectomy radiotherapy. Int J Radiat Oncol Biol Phys 59(2):329–340CrossRefPubMedGoogle Scholar
  2. 2.
    Macdonald OK, Schild SE, Vora SA et al (2004) Salvage radiotherapy for palpable, locally recurrent prostate cancer after radical prostatectomy. Int J Radiat Oncol Biol Phys 58(5):1530–1535CrossRefPubMedGoogle Scholar
  3. 3.
    Anscher MS (2004) Salvage radiotherapy for recurrent prostate cancer: the earlier the better. JAMA 291(11):1380–1382CrossRefPubMedGoogle Scholar
  4. 4.
    Tomita N, Kodaira T, Furutani K et al (2009) Early salvage radiotherapy for patients with PSA relapse after radical prostatectomy. J Cancer Res Clin Oncol 135(11):1561–1567CrossRefPubMedGoogle Scholar
  5. 5.
    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):572–583Google Scholar
  6. 6.
    Niibe Y, Chang JY (2012) Novel insights of oligometastases and oligo-recurrence and review of the literature. Pulm Med 2012:261096PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Alongi F, Arcangeli S, Filippi AR, Ricardi U, Scorsetti M (2012) Review and uses of stereotactic body radiation therapy for oligometastases. Oncologist 17(8):1100–1107PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Amling CL, Blute ML, Bergstralh EJ, Seay TM, Slezak J, Zincke H (2000) Long-term hazard of progression after radical prostatectomy for clinically localized prostate cancer: continued risk of biochemical failure after 5 years. J Urol 164:101–105CrossRefPubMedGoogle Scholar
  9. 9.
    Chun FK, Graefen M, Zacharias M et al (2005) Anatomic radical retropubic prostatectomy long-term recurrence-free survival rates for localized prostate cancer. World J Urol 24:273–280CrossRefGoogle Scholar
  10. 10.
    Han M, Partin AW, Pound CR, Epstein JI, Walsh PC (2001) Long-term biochemical disease free and cancer-specific survival following anatomic radical retropubic prostatectomy: the 15-year Johns Hopkins experience. Urol Clin North Am 28:555–565CrossRefPubMedGoogle Scholar
  11. 11.
    Bianco FJ Jr, Scardino PT, Eastham JA (2005) Radical prostatectomy: long term cancer control and recovery of sexual and urinary function (“trifecta”). Urology 66:83–94CrossRefPubMedGoogle Scholar
  12. 12.
    Trabulsi EJ, Valicenti RK, Hanlon AL et al (2008) A multi-institutional matched-control analysis of adjuvant and salvage postoperative radiation therapy for pT3-4N0 prostate cancer. Urology 72:1298–1302PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Geinitz H, Riegel MG, Thamm R et al (2012) Outcome after conformal salvage radiotherapy in patients with rising prostate specific antigen levels after radical prostatectomy. Int J Radiat Oncol Biol Phys 82:1930–1937CrossRefPubMedGoogle Scholar
  14. 14.
    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:b4817PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Tsujimura A (2013) Role of androgen in the elderly. Problems of androgen deprivation therapy. Clin Calcium 23(8):1185–1190PubMedGoogle Scholar
  16. 16.
    Hamberg P, Verhagen PC, de Wit R (2008) When to start cytotoxic therapy in asymptomatic patients with hormone refractory prostate cancer? Eur J Cancer 44:1193–1197CrossRefPubMedGoogle Scholar
  17. 17.
    Chambers AF, Groom AC, MacDonald IC (2002) Dissemination and growth of cancer cells in metastatic sites. Nat Rev Cancer 2(8):563–572CrossRefPubMedGoogle Scholar
  18. 18.
    Kal HB, Van Gellekom MP (2003) How low is the alpha/beta ratio for prostate cancer? Int J Radiat Oncol Biol Phys 57:1116–1121CrossRefPubMedGoogle Scholar
  19. 19.
    Wang JZ, Li XA, Yu CX, DiBiase SJ (2003) The low alpha/beta ratio for prostate cancer: what does the clinical outcome of HDR brachytherapy tell us? Int J Radiat Oncol Biol Phys 57:1101–1108CrossRefPubMedGoogle Scholar
  20. 20.
    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(2):889–897Google Scholar
  21. 21.
    Catton C, Gospodarowicz M, Warde P et al (2001) Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol 59:51–60CrossRefPubMedGoogle Scholar
  22. 22.
    Stephenson AJ, Shariat S, Zelefsky M et al (2004) Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA 291:1325–1332CrossRefPubMedGoogle Scholar
  23. 23.
    Strom TJ, Wilder RB, Fernandez DC, Mellon EA, Saini AS, Hunt DC, Biagioli MC (2014) High-dose-rate brachytherapy with or without intensity modulated radiation therapy as salvage treatment for an isolated, gross local recurrence of prostate cancer post-prostatectomy. Brachytherapy 13(2):123–127Google Scholar
  24. 24.
    Gomez-Veiga F, Mariño A, Alvarez L, Rodriguez I, Fernandez C, Pertega S, Candal A (2012) Brachytherapy for the treatment of recurrent prostate cancer after radiotherapy or radical prostatectomy. BJU Int 109(Suppl 1):17–21CrossRefPubMedGoogle Scholar
  25. 25.
    Jung C, Cookson MS, Chang SS, Smith JA Jr, Dietrich MS, Teng M (2007) Toxicity following high-dose salvage radiotherapy after radical prostatectomy. BJU Int 99(3):529–533CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • B. Detti
    • 1
  • P. Bonomo
    • 1
  • L. Masi
    • 2
  • R. Doro
    • 2
  • S. Cipressi
    • 2
  • C. Iermano
    • 2
  • I. Bonucci
    • 2
  • D. Franceschini
    • 1
  • L. Di Brina
    • 1
  • M. Baki
    • 1
  • G. Simontacchi
    • 1
  • I. Meattini
    • 1
  • M. Carini
    • 3
  • S. Serni
    • 3
  • G. Nicita
    • 3
  • L. Livi
    • 1
  1. 1.Radiotherapy Unit, Azienda Ospedaliera Universitaria CareggiUniversity of FlorenceFlorenceItaly
  2. 2.CyberKnife Center- I.F.C.A (Istituto Fiorentino di Cura ed Assistenza)University of FlorenceFlorenceItaly
  3. 3.Urology Unit, Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly

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