Abstract
Purpose
We herein present the results of the first Italian Association of Radiotherapy and Clinical Oncology (AIRO) survey regarding salvage external beam re-irradiation of local prostate cancer relapse named PROLAPSE.
Methods
A questionnaire with 12 items was administered to the 775 Italian radiation oncologist members of the AIRO.
Results
One hundred of the members completed the survey. The survey highlighted that 59% of the participants are currently performing prostate re-EBRT, while nearly two-thirds (65%) affirmed that they are taking into consideration the procedure in case of intraprostatic relapse. Regarding the clinical target volume (CTV), only a minority (16%) declared to always prefer the partial prostate re-irradiation, while a consistent portion (nearly two-thirds) relied on clinical considerations of the choice towards partial or whole gland irradiation. The main techniques used for re-irradiation resulted to be intensity-modulated RT (IMRT)/volumetric modulated arc therapy (VMAT) and SBRT, having received approximately 40% of responses each. Regarding the criteria for patients’ selection, more than 75% of responders agreed on the use of positron emission tomography (PET)/computed tomography (CT)-choline to exclude distant metastases and of multiparametric magnetic resonance imaging (mp-MRI) to detect intraprostatic recurrence. A sufficient timeframe (> 3 years) between primary RT and reirradiation was indicated by more than half of participants as an important driver in decision-making, while histological confirmation of the relapse was considered not essential by more than two-thirds. For the use of concomitant androgen deprivation therapy (ADT), most AIRO members (79%) agreed that the prescription should be based on a case-by-case analysis. Extreme hypofractionation (> 5 Gy/fraction) was preferred by the majority (52%) of the AIRO members. In most centers (more than 74%), the planning dose–volume constraints were generally extrapolated from the published data. In half of the cases, the interviewed responders affirmed that no major gastrointestinal (GI) and genitourinary (GU) toxicities were registered in the follow-up of their re-EBRT patients. Bladder complications represented the most commonly observed form of toxicity, with an incidence of 67%.
Conclusion
This first AIRO survey about salvage prostate re-EBRT provides an interesting snapshot and suggests increasing interest in re-EBRT patients in Italy. Consensus about some aspects of patients’ selection, the necessity of biopsy, fractionation, and highly selective techniques seems feasible, but other key points such as irradiated volume, dosimetry parameters, and hormonal treatment association need to be clarified.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- ACROP:
-
Advisory Committee on Radiation Oncology Practice
- ADT:
-
Androgen deprivation therapy
- AIRO:
-
Italian Association of Radiotherapy and Clinical Oncology
- CT:
-
Computed tomography
- CTV:
-
Clinical target volume
- ESTRO:
-
European Society for Radiotherapy and Oncology
- GI:
-
Gastrointestinal
- GU:
-
Genitourinary
- HIFU:
-
High-intensity focused ultrasound
- IGRT:
-
Image-guided radiotherapy
- IMRT:
-
Intensity-modulated RT
- LINAC:
-
Linear accelerator
- mp-MRI:
-
Multiparametric magnetic resonance imaging
- OAR:
-
Organ at risk
- PCa:
-
Prostate cancer
- PET:
-
Positron emission tomography
- QoL:
-
Quality of life
- re-EBRT:
-
External beam re-irradiation
- RT:
-
Radiotherapy
- SBRT:
-
Stereotactic body RT
- SRP:
-
Salvage radical prostatectomy
- VMAT:
-
Volumetric modulated arc therapy
References
Agarwal PK, Sadetsky N, Konety BR, Resnick MI, Carroll PR (2008) Treatment failure after primary and salvage therapy for prostate cancer: likelihood, patterns of care, and outcomes. Cancer 112(2):307–314. https://doi.org/10.1002/cncr.23161
Alongi F et al (2013) Salvage therapy of intraprostatic failure after radical external-beam radiotherapy for prostate cancer: a review. Crit Rev Oncol Hematol 88(3):550–563. https://doi.org/10.1016/j.critrevonc.2013.07.009
Bomers JGR et al (2020) Focal salvage MR imaging-guided cryoablation for localized prostate cancer recurrence after radiotherapy: 12-month follow-up. J Vasc Interv Radiol 31(1):35–41. https://doi.org/10.1016/j.jvir.2019.07.001
Cuccia F, Nicosia L, Mazzola R, Figlia V, Giaj-Levra N, Ricchetti F, Rigo M, Vitale C, Corradini S, Alongi F (2020) LINAC-based SBRT as a feasible and safe salvage retreatment approach for local recurrence in previously irradiated prostate cancer patients. Strahlenther Onkol. https://doi.org/10.1007/s00066-020-01628-6(Epub ahead of print)
D’Amico AV, Cote K, Loffredo M, Renshaw AA, Schultz D (2002) Determinants of prostate cancer-specific survival after radiation therapy for patients with clinically localized prostate cancer. J Clin Oncol 20(23):4567–4573. https://doi.org/10.1200/JCO.2002.03.061
Fuller D et al (2020) Retreatment for local recurrence of prostatic carcinoma after prior therapeutic irradiation: efficacy and toxicity of HDR-like SBRT. Int J Radiat Oncol Biol Phys 106(2):291–299. https://doi.org/10.1016/j.ijrobp.2019.10.014
Gregucci F et al (2020) Present clinical practice of breast cancer radiotherapy in Italy: a nationwide survey by the Italian Society of Radiotherapy and Clinical Oncology (AIRO) Breast Group. Radiol Med. https://doi.org/10.1007/s11547-020-01147-5
Høyer M (2017) Re-irradiation with stereotactic body radiation therapy (SBRT). Chin Clin Oncol 6(Suppl 2):S15. https://doi.org/10.21037/cco.2017.07.01
Jereczek-Fossa BA et al (2019) Reirradiation for isolated local recurrence of prostate cancer: mono-institutional series of 64 patients treated with salvage stereotactic body radiotherapy (SBrT). Br J Radiol. https://doi.org/10.1259/bjr.20180494
Jereczek-Fossa BA, Marvaso G, Pepa M et al (2020) A Delphi consensus on salvage stereotactic body radiotherapy for intraprostatic relapse after prostate cancer radiotherapy, an ESTRO ACROP study. Accepted as an Oral presentation at ESTRO 39 Congress, Vienna 3–7 April 2020
Kaljouw E, Pieters BR, Kovács G, Hoskin PJ (2016) A Delphi consensus study on salvage brachytherapy for prostate cancer relapse after radiotherapy, a Uro-GEC study. Radiother Oncol 118(1):122–130. https://doi.org/10.1016/j.radonc.2015.10.021
Leroy T, Lacornerie T, Bogart E, Nickers P, Lartigau E, Pasquier D (2017) Salvage robotic SBRT for local prostate cancer recurrence after radiotherapy: preliminary results of the Oscar Lambret Center. Radiat Oncol 12(1):95. https://doi.org/10.1186/s13014-017-0833-9
Mariucci C, Ingrosso G, Bini V, Saldi S, Lupattelli M, Frattegiani A, Perrucci E, Palumbo I, Falcinelli L, Centofanti G, Bellavita R, Aristei C (2020) Helical tomotherapy re-irradiation for patients affected by local radiorecurrent prostate cancer. Rep Pract Oncol Radiother. 25(2):157–162. https://doi.org/10.1016/j.rpor.2020.01.005
Mazzola R, Cuccia F, Figlia V, Giaj-Levra N, Nicosia L, Ricchetti F, Rigo M, Pasinetti N, Salgarello M, Alongi F (2019) New metabolic tracers for detectable PSA levels in the post-prostatectomy setting: is the era of melting glaciers upcoming? Transl Androl Urol 8(Suppl 5):S538–S541. https://doi.org/10.21037/tau.2019.12.34
Pasquier D et al (2019) Salvage stereotactic body radiation therapy for local prostate cancer recurrence after radiation therapy: a retrospective multicenter study of the GETUG. Int J Radiat Oncol Biol Phys 105(4):727–734. https://doi.org/10.1016/j.ijrobp.2019.07.012
Pucar D et al (2007) Clinically significant prostate cancer local recurrence after radiation therapy occurs at the site of primary tumor: magnetic resonance imaging and step-section pathology evidence. Int J Radiat Oncol Biol Phys 69(1):62–69. https://doi.org/10.1016/j.ijrobp.2007.03.065
Rutenberg MS, Meister M, Amin PP, Hussain A, Naslund MJ, Kwok Y (2016) Salvage external beam radio-therapy for locally recurrent prostate cancer after definitive brachytherapy. Brachytherapy. 15(6):722–729. https://doi.org/10.1016/j.brachy.2016.08.004
Tran H, Kwok J, Pickles T, Tyldesley S, Black PC (2014) Underutilization of local salvage therapy after radiation therapy for prostate cancer. Urol Oncol Semin Orig Investig 32(5):701–706. https://doi.org/10.1016/j.urolonc.2013.12.014
Wang H et al (2009) 18F-fluorocholine PET-guided target volume delineation techniques for partial prostate re-irradiation in local recurrent prostate cancer. Radiother Oncol 93(2):220–225. https://doi.org/10.1016/j.radonc.2009.08.037
Zerini D et al (2015) Salvage image-guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer. Br J Radiol. https://doi.org/10.1259/bjr.20150197
Zilli T, Benz E, Dipasquale G, Rouzaud M, Miralbell R (2016) Reirradiation of prostate cancer local failures after previous curative radiation therapy: long-term outcome and tolerance. Int J Radiat Oncol Biol Phys 96(2):318–322. https://doi.org/10.1016/j.ijrobp.2016.05.024
Acknowledgements
The Authors thank the Scientific Committee and Board of the AIRO for the critical revision of the paper. The Authors thank Mattia Zaffaroni MSc for his help in the final revision of the manuscript.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of interest
All the authors declare no conflict of interest in relation to the Survey.
Ethical approval
Written informed consent was obtained from all patients who underwent radiotherapy, and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Zerini, D., Jereczek-Fossa, B.A., Ciabattoni, A. et al. PROLAPSE: survey about local prostate cancer relapse salvage treatment with external beam re-irradiation: results of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). J Cancer Res Clin Oncol 146, 2311–2317 (2020). https://doi.org/10.1007/s00432-020-03297-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-020-03297-5