Salvage radiotherapy for macroscopic local recurrences after radical prostatectomy : A national survey on patterns of practice.

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.

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.

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.

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.

Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. 2017 Jun 27 [Epub ahead of print]

Alan Dal Pra, Cedric Panje, Thomas Zilli, Winfried Arnold, Kathrin Brouwer, Helena Garcia, Markus Glatzer, Silvia Gomez, Fernanda Herrera, Khanfir Kaouthar, Alexandros Papachristofilou, Gianfranco Pesce, Christiane Reuter, Hansjörg Vees, Daniel Rudolf Zwahlen, Daniel Engeler, Paul Martin Putora

Department of Radiation Oncology, Bern University Hospital, Inselspital Bern, Freiburgstrasse, 3010, Bern, Switzerland. ., Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland., Department of Radiation Oncology, Hospitaux Universitaires de Génève, Génève, Switzerland., Department of Radiation Oncology, Luzerner Kantonsspital, Luzerner, Switzerland., Department of Radiation Oncology, Stadtspital Triemli, Zürich, Switzerland., Department of Radiation Oncology, Universitätsspital Zürich, Zürich, Switzerland., Department of Radiation Oncology, Kantonsspital Aarau, Aarau, Switzerland., Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., Department of Radiation Oncology, Hôpital du Valais, Sion, Switzerland., Department of Radiation Oncology, Universitätsspital Basel, Basel, Switzerland., Department of Radiation Oncology, EOC Bellinzona, Bellinzona, Switzerland., Department of Radiation Oncology, Kantonsspital Münsterlingen, Münsterlingen, Switzerland., Department of Radiation Oncology, Klinik Hirslanden, Zürich, Switzerland., Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland., Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland.