Felipe Couñago1,2,3, Ana Aurora Díaz Gavela1,2,3, Gemma Sancho4, Irene Ortiz5, Francisco José Marcos1,2,3, Manuel Recio6, Julio Fernández6, Raquel Cano6, Mar Jiménez6, Israel J Thuissard7, David Sanz-Rosa8, Juan Castro Nováis9, Eduardo Pardo9, Yolanda Molina9, Hugo Pérez García9, Elia Del Cerro1,2,3. 1. Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain. 2. Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain. 3. Universidad Europea, Madrid 28670, Spain. 4. Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona 08041, Spain. 5. Department of Radiation Oncology, Hospital Universitario Son Espases, Palma de Mallorca 07120, Spain. 6. Department of Radiology, Hospital Universitario Quirónsalud, Madrid 28223, Spain. 7. Department of Research, Universidad Europea, Madrid 28670, Spain. 8. Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28670, Spain. 9. Department of Medical Physics, Hospital Universitario Quirónsalud, Madrid 28223, Spain.
Abstract
AIM: To analyse the efficacy and toxicity of postprostatectomy SRT in patients with a BCR evaluated with mpMRI. BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) has the ability to detect the site of pelvic recurrence in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). However, we do not know the oncological outcomes of mpMRI-guided savage radiotherapy (SRT). RESULTS: Local, lymph node, and pelvic bone recurrence was observed in 13, 4 and 2 patients, respectively. PSA levels were significantly lower in patients with negative mpMRI (0.4 ng/mL [0.4]) vs. positive mpMRI (2.2 ng/mL [4.1], p = 0.003). Median planning target volume doses in patients with visible vs. non-visible recurrences were 76 Gy vs. 70 Gy. Overall, mean follow-up was 41 months (6-81). Biochemical relapse-free survival (bRFS) at 3 years was 82.3% and 82.5%, respectively, for the negative and positive mpMRI groups (p = 0.800). Three-year rates of late grade ≥2 urinary and rectal toxicity were 14.8% and 1.9%, respectively; all but one patient recovered without sequelae. CONCLUSION: SRT to the macroscopic recurrence identified by mpMRI is a feasible and well-tolerated option. In this study, there were no differences in bRFS between MRI-positive and MRI-negative patients, indicating effective targeting of MRI-positive lesions.
AIM: To analyse the efficacy and toxicity of postprostatectomy SRT in patients with a BCR evaluated with mpMRI. BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) has the ability to detect the site of pelvic recurrence in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). However, we do not know the oncological outcomes of mpMRI-guided savage radiotherapy (SRT). RESULTS: Local, lymph node, and pelvic bone recurrence was observed in 13, 4 and 2 patients, respectively. PSA levels were significantly lower in patients with negative mpMRI (0.4 ng/mL [0.4]) vs. positive mpMRI (2.2 ng/mL [4.1], p = 0.003). Median planning target volume doses in patients with visible vs. non-visible recurrences were 76 Gy vs. 70 Gy. Overall, mean follow-up was 41 months (6-81). Biochemical relapse-free survival (bRFS) at 3 years was 82.3% and 82.5%, respectively, for the negative and positive mpMRI groups (p = 0.800). Three-year rates of late grade ≥2 urinary and rectal toxicity were 14.8% and 1.9%, respectively; all but one patient recovered without sequelae. CONCLUSION: SRT to the macroscopic recurrence identified by mpMRI is a feasible and well-tolerated option. In this study, there were no differences in bRFS between MRI-positive and MRI-negative patients, indicating effective targeting of MRI-positive lesions.
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