Image-Guided Robotic Radiosurgery as Salvage Therapy for Locally Recurrent Prostate Cancer after External Beam Irradiation: Retrospective Feasibility Study on Six Cases

Author:

Vavassori Andrea1,Jereczek-Fossa Barbara Alicja12,Beltramo Giancarlo3,De Cicco Luigi1,Fariselli Laura4,Bianchi Livia Corinna3,Possanzini Marco3,Bergantin Achille5,DeCobelli Ottavio26,Orecchia Roberto12

Affiliation:

1. Department of Radiotherapy, European Institute of Oncology, Milan, Italy

2. University of Milan, Milan, Italy

3. Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy

4. Radiotherapy Unit of the C Besta Neurological Institute Foundation, Milan, Italy

5. Department of Medical Physics, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy

6. Department of Urology, European Institute of Oncology, Milan, Italy

Abstract

Aims and background Technological advances in treatment planning and execution are providing new potential opportunities in the treatment of recurrent prostate cancer. This study was conducted to evaluate the feasibility and safety of reirradiation with image-guided radiosurgery using CyberKnife, a robotic arm-driven compact linear accelerator, for intraprostatic recurrence after external beam radiotherapy (EBRT). Methods Between September 2007 and May 2008, 6 patients diagnosed with locally recurrent prostate cancer after EBRT were treated using the CyberKnife system. The total reirradiation dose was 30 Gy in five fractions. Prior to radiosurgery four patients were treated with androgen-deprivation therapy. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and the Houston-Phoenix definition (PSA nadir + 2 ng/mL) were used for toxicity and biochemical failure evaluation, respectively. Results After a median follow-up of 11.2 months (range, 9.6–18.6 months), all patients are alive with no evidence of severe urinary or rectal acute morbidity. Local control cannot be exactly determined due to the short follow-up and the bias of the use of androgen ablation. Four patients had biochemical failure, three of them with clinical failure evidence (lymph node, bone and lung metastasis, respectively): none of these patients had clinical evidence of tumor persistence in the prostate. Conclusions Salvage radiosurgery with CyberKnife after irradiation is feasible with low urinary and rectal morbidity. A longer follow-up and a larger number of patients are necessary to evaluate its effectiveness and optimal patient selection criteria.

Publisher

SAGE Publications

Subject

Cancer Research,Oncology,General Medicine

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