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Salvage Stereotactic Reirradiation for Local Recurrence in the Prostatic Bed After Prostatectomy: A Retrospective Multicenter Study - Beyond the Abstract

In the era of PET and multiparametric MRI, the diagnosis of a local recurrence in the prostatic bed particularly after previous salvage radiotherapy appears to be more frequent and a potential stereotactic re-irradiation could be discussed. However, stereotactic re-irradiation in this context has been evaluated in some retrospective studies with a very limited sample size only.1–7 This is the reason why we conducted the largest retrospective multicenter study of salvage re-irradiation in the prostatic bed including 117 patients treated in 11 centers in Europe

The recurrence in the prostatic bed was diagnosed in 66% with a combination of MRI and PET-CT (86% of choline PET-CT). The use rate of PSMA PET-CT was low because of the inclusion period. With improved availability in the next coming years, PSMA PET-CT could help to select patients due to its high sensitivity.

The total dose of stereotactic body radiotherapy (SBRT) was mostly 30 Gy to 36 Gy in 5 to 6 fractions with no statistical difference in PTV and GTV coverage.

Our primary results show that small recurrences (< 10cm3) located far from the urethrovesical anastomosis with a D2% bladder as low as achievable are associated with a higher chance of local control with the lowest risk of toxicity in multivariable analysis.

Poorer progression free survival in patients with a recurrence in contact with the urethrovesical anastomosis could be explained by a difficulty to delineate the GTV.

Due to potential toxicity, these treatments should be considered with caution, and ideally in the context of a clinical trial or registry. Of note, one study is already ongoing: the REPAIR GETUG P16 (NCT04536805) study may precisely determine the role of salvage SBRT and the target population in this context.

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Figure 1 – Treatment plan of a stereotactic re-irradiation for a retro-vesical recurrence in the prostatic bed

Written by :

  • Paul Archer, MD, Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
  • David Pasquier, MD, PhD, Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; Univ. Lille, Centre de recherche en informatique, Signal et automatique de Lille, Cristal UMR 9189, Lille, France

References :

  1. Olivier J, Basson L, Puech P, et al. Stereotactic re-irradiation for local recurrence in the prostatic bed after prostatectomy: preliminary results. Front Oncol 2019;9:71.
  2. Jereczek-Fossa BA, Rojas DP, Zerini D, et al. Reirradiation for isolated local recurrence of prostate cancer: mono-institutional series of 64 patients treated with salvage stereotactic body radiotherapy (SBRT). Br J Radiol 2019;92:20180494.
  3. Janoray G, Reynaud-Bougnoux A, Ruffier-Loubière A, Bernadou G, Pointreau Y, Calais G. Stereotactic body re-irradiation therapy for locally recurrent prostate cancer after external-beam radiation therapy: Initial report. Cancer/Radiothérapie 2016;20:275–81.
  4. Detti B, Bonomo P, Masi L, et al. CyberKnife stereotactic radiotherapy for isolated recurrence in the prostatic bed. World J Urol 2016;34:311–7.
  5. Loi M, Di Cataldo V, Simontacchi G, et al. Robotic stereotactic retreatment for biochemical control in previously irradiated patients affected by recurrent prostate cancer. Clin Oncol 2018;30:93–100.
  6. D’Agostino GR, Di Brina L, Mancosu P, et al. Reirradiation of locally recurrent prostate cancer with volumetric modulated arc therapy. Int J Radiat Oncol 2019;104:614–21.
  7. Perennec T, Vaugier L, Toledano A, et al. Stereotactic re-irradiation for local recurrence after radical prostatectomy and radiation therapy: a retrospective multicenter study. Cancers 2021;13:4339.

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