Fernando Munoz1, Francesco Fiorica2, Luciana Caravatta3, Consuelo Rosa4, Letizia Ferella1, Luca Boldrini5, Bruno Fionda5, Anna Rita Alitto5, Alessia Nardangeli5, Francesco Dionisi6, Stefano Arcangeli7, Alessandro Di Marzo8, Antonio Pontoriero9, Vittorio Donato10, Mariangela Massaccesi5. 1. Radiotherapy Unit, Parini Hospital, Viale Ginevra 3, 11100 Aosta, Italy. 2. Department of Radiation Oncology and Nuclear Medicine, State Hospital Mater Salutis AULSS 9, Via Carlo Gianella, 1, 37045 Legnago (VR), Italy. 3. Radiation Oncology Unit, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100 Chieti, Italy. 4. Radiation Oncology Unit, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100 Chieti, Italy. Electronic address: c.rosa155@gmail.com. 5. Department of Radiological, Radiotherapy and Hematology Sciences, Fondazione Policlinico Universitario "A. Gemelli", Catholic University of Sacred Heart, Via della Pineta Sacchetti, 217, 00168 Rome, Italy. 6. Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari, APSS, Via Alcide Degasperi 79, 38123 Trento, Italy. 7. Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan "Bicocca", Via Sansovino, 4, 20133 Milan, Italy. 8. Radiotherapy Oncology Centre, "S. Maria" Hospital, Viale Tristano di Joannuccio, 05100 Terni, Italy. 9. Operative Unit of Radiation Oncology, Department of Image Diagnostics, University Hospital "G. Martino", Messina, Italy. 10. Radiation Oncology, Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152 Rome, Italy.
Abstract
AIMS: The best therapeutic approach for local relapses of previously irradiated prostate cancer (PC) is still not defined. Re-irradiation (Re-I) could offer a chance of cure for highly selected patients, although high quality evidences are lacking. The aim of our study is to provide a literature review on efficacy and safety of Re-I. METHODS: Only studies where Re-I field overlaps with previous radiotherapy were considered. To determine 2 and 4 years overall mortality (OM), 2 and 4 years biochemical failure (BF) and pooled acute and late G ≥ 3 toxicities rate, a meta-analysis over single arm study was performed. RESULTS: Thirty-eight studies with 1194 patients were included. Median follow-up from Re-I was 30 months (10-94 months). Brachytherapy (BRT) was the most used Re-I technique (27 studies), followed by Stereotactic Body Radiotherapy (SBRT) (9) and External Beam Radiation Therapy (EBRT) (2). Re-I prescription doses ranged from 19 Gy in single HDR fraction to 145 Gy (interstitial BRT). The pooled 2 and 4 years OM rates were 2.1% (95%CI:1.1-3.7%, P < 0.001) and 12.5% (95%CI:8.1-19.5%; P < 0.001). The pooled 2 years BF rate was 24% (95% CI: 19.1-30.2%, P < 0.001). The pooled 4 years BF was 35.6% (95% CI: 28.7-44.3%, P < 0.001). The pooled result of G ≥ 3 acute toxicity was 1.4% (95%CI: 0.7-3%, P < 0.001). One hundred and three G ≥ 3 late adverse events were reported, with a pooled result of G ≥ 3 late toxicity of 8.7% (95%CI: 5.8-13%, P < 0.001). CONCLUSIONS: Re-I of local failures from PC showed promising OM and biochemical control rates with a safe toxicity profile.
AIMS: The best therapeutic approach for local relapses of previously irradiated prostate cancer (PC) is still not defined. Re-irradiation (Re-I) could offer a chance of cure for highly selected patients, although high quality evidences are lacking. The aim of our study is to provide a literature review on efficacy and safety of Re-I. METHODS: Only studies where Re-I field overlaps with previous radiotherapy were considered. To determine 2 and 4 years overall mortality (OM), 2 and 4 years biochemical failure (BF) and pooled acute and late G ≥ 3 toxicities rate, a meta-analysis over single arm study was performed. RESULTS: Thirty-eight studies with 1194 patients were included. Median follow-up from Re-I was 30 months (10-94 months). Brachytherapy (BRT) was the most used Re-I technique (27 studies), followed by Stereotactic Body Radiotherapy (SBRT) (9) and External Beam Radiation Therapy (EBRT) (2). Re-I prescription doses ranged from 19 Gy in single HDR fraction to 145 Gy (interstitial BRT). The pooled 2 and 4 years OM rates were 2.1% (95%CI:1.1-3.7%, P < 0.001) and 12.5% (95%CI:8.1-19.5%; P < 0.001). The pooled 2 years BF rate was 24% (95% CI: 19.1-30.2%, P < 0.001). The pooled 4 years BF was 35.6% (95% CI: 28.7-44.3%, P < 0.001). The pooled result of G ≥ 3 acute toxicity was 1.4% (95%CI: 0.7-3%, P < 0.001). One hundred and three G ≥ 3 late adverse events were reported, with a pooled result of G ≥ 3 late toxicity of 8.7% (95%CI: 5.8-13%, P < 0.001). CONCLUSIONS: Re-I of local failures from PC showed promising OM and biochemical control rates with a safe toxicity profile.
Authors: Michael D Chuong; John M Bryant; Roberto Herrera; James McCulloch; Jessika Contreras; Rupesh Kotecha; Tino Romaguera; Diane Alvarez; Matthew D Hall; Muni Rubens; Minesh P Mehta; Adeel Kaiser; Martin Tom; Alonso N Gutierrez; Kathryn E Mittauer Journal: Adv Radiat Oncol Date: 2021-10-27