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Salvage radiotherapy for macroscopic local recurrences after radical prostatectomy

A national survey on patterns of practice

Salvage-Radiotherapie bei makroskopischen Lokalrezidiven nach radikaler Prostatektomie

Nationale Umfrage zu Behandlungsmustern

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Abstract

Introduction

Although salvage radiotherapy (SRT) for PSA recurrence after radical prostatectomy provides better oncological outcomes when delivered early, in the absence of detectable disease many patients are treated for macroscopic locally recurrent tumors. Due to limited data from prospective studies, we hypothesized an important variability in the SRT management of these patients. Our aim was to investigate current practice patterns of SRT for local macroscopic recurrence after radical prostatectomy.

Material and methods

A total of 14 Swiss radiation oncology centers were asked to complete a survey on treatment specifications for macroscopic locally recurrent disease including information on pretherapeutic diagnostic procedures, dose prescription, radiation delivery techniques and androgen deprivation therapy (ADT). Treatment recommendations on ADT were analyzed using the objective consensus methodology.

Results

The majority of centers recommended pretreatment magnetic resonance imaging (MRI) of the pelvis and choline positron emission tomography (PET). The median prescribed dose to the prostate bed was 66 Gy (range 65–72 Gy) with a boost to the macroscopic lesion used by 79% of the centers with a median total dose of 72 Gy (range 70–80 Gy). Intensity-modulated rotational techniques were used by all centers and daily cone beam computed tomography (CT) was recommended by 43%. The use of concomitant ADT for any macroscopic recurrence was recommended by 43% of the centers while the remaining centers recommended it only for high-risk disease, which was not consistently defined.

Conclusion

We observed a high variability of treatment paradigms when SRT is indicated for macroscopic local recurrences after prostatectomy. These data reflect the need for more standardized approaches and ultimately further research in this field.

Zusammenfassung

Einleitung

Obwohl die Evidenz für eine frühzeitige Salvage-Radiotherapie (SRT) bei einem PSA-Rezidiv nach radikaler Prostatektomie spricht, werden viele Patienten erst bei einem makroskopischen Lokalrezidiv behandelt. Hier scheint es jedoch aufgrund der fehlenden Daten aus prospektiven Studien eine Variabilität der Behandlungskonzepte zu geben. Das Ziel der Studie war es, die aktuelle Behandlungspraxis in der SRT des makroskopischen Rezidivs eines Prostatakarzinoms zu untersuchen.

Material und Methoden

Insgesamt 14 Schweizer Strahlentherapiezentren wurden für eine Umfrage zu den Behandlungsparametern beim makroskopischen Lokalrezidiv eines Prostatakarzinoms kontaktiert und nach diagnostischen Maßnahmen, Dosisverschreibung, Strahlentherapietechniken und antihormoneller Therapie (ADT) befragt. Die variierenden Indikationen zur ADT wurden mittels der Objective-konsensus-Methodologie ausgewertet.

Ergebnisse

Die Mehrheit der Zentren empfahl vor der Therapie eine Magnetresonanztomographie (MRT) des Beckens und eine Cholin-Positronenemissionstomographie (PET). Die mediane verschriebene Dosis für die Prostataloge war 66 Gy (65–72 Gy) mit einem Boost auf das makroskopische Lokalrezidiv in 79 % der Zentren bis zu einer medianen Dosis von 72 Gy (70–80 Gy). Alle Zentren verwendeten intensitätsmodulierte Rotationstechniken, ein tägliches Cone-beam-CT wurde in 43 % der Zentren empfohlen. Eine begleitende ADT wurde von 43 % für jedes makroskopische Lokalrezidiv empfohlen, während die übrigen Zentren dies nur bei Hochrisikogruppen (mit unterschiedlichen Definitionen) durchführten.

Schlussfolgerung

Es wurde eine hohe Variabilität der Behandlungskonzepte für die SRT des makroskopischen Lokalrezidivs nach Prostatektomie beobachtet. Dies zeigt den Bedarf an standardisierten Behandlungskonzepten und weiteren Studien in diesem Bereich auf.

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Acknowledgements

ADP and CP contributed equally to the manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Bern University Hospital, Inselspital Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Alan Dal Pra

  2. Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Cedric Panje, Markus Glatzer & Paul Martin Putora

  3. Department of Radiation Oncology, Hospitaux Universitaires de Génève, Génève, Switzerland

    Thomas Zilli

  4. Department of Radiation Oncology, Luzerner Kantonsspital, Luzerner, Switzerland

    Winfried Arnold

  5. Department of Radiation Oncology, Stadtspital Triemli, Zürich, Switzerland

    Kathrin Brouwer

  6. Department of Radiation Oncology, Universitätsspital Zürich, Zürich, Switzerland

    Helena Garcia

  7. Department of Radiation Oncology, Kantonsspital Aarau, Aarau, Switzerland

    Silvia Gomez

  8. Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Fernanda Herrera

  9. Department of Radiation Oncology, Hôpital du Valais, Sion, Switzerland

    Khanfir Kaouthar

  10. Department of Radiation Oncology, Universitätsspital Basel, Basel, Switzerland

    Alexandros Papachristofilou

  11. Department of Radiation Oncology, EOC Bellinzona, Bellinzona, Switzerland

    Gianfranco Pesce

  12. Department of Radiation Oncology, Kantonsspital Münsterlingen, Münsterlingen, Switzerland

    Christiane Reuter

  13. Department of Radiation Oncology, Klinik Hirslanden, Zürich, Switzerland

    Hansjörg Vees

  14. Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland

    Daniel Rudolf Zwahlen

  15. Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Daniel Engeler

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  1. Alan Dal Pra
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Correspondence to Alan Dal Pra.

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Conflict of interest

A. Dal Pra, C. Panje, T. Zilli, W. Arnold, K. Brouwer, H. Garcia, M. Glatzer, S. Gomez, F. Herrera, K. Kaouthar, A. Papachristofilou, G. Pesce, C. Reuter, H. Vees, D. Zwahlen, D. Engeler and P.M. Putora declare that they have no competing interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Alan Dal Pra and Cedric Panje have contributed equally to this manuscript.

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Dal Pra, A., Panje, C., Zilli, T. et al. Salvage radiotherapy for macroscopic local recurrences after radical prostatectomy. Strahlenther Onkol 194, 9–16 (2018). https://doi.org/10.1007/s00066-017-1172-3

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