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Post-HIFU locally relapsed prostate cancer: high-dose salvage radiotherapy guided by molecular imaging

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Abstract

Purpose

To evaluate tolerance and biochemical control rates of salvage external beam radiotherapy (EBRT) in patients with local relapse from prostate cancer (PC) after high-intensity focused ultrasound (HIFU) as primary treatment.

Methods

Twenty-four patients presented biochemical failure of PC. Salvage EBRT to the residual prostate was performed with moderate hypofractionation schedule (MHRT) in 28 fractions (n = 16) or with extreme hypofractionation schedule (SBRT) in 5 fractions (n = 8) by means of image-guided volumetric modulation arc therapy. In case of MHRT, the median dose was 71.4 Gy, whereas in case of SBRT it was 32.5 Gy.

Results

The median follow-up was 28 months. The median PSA nadir was 0.26 ng/mL. In case of MHRT, the median PSA nadir was 0.15 ng/mL and occurred within a median time of 19 months. In case of SBRT, the median PSA nadir was 0.64 ng/mL and occurred within a median time of 8 months. No G3 higher acute or late toxicity after EBRT was observed. Only three patients presented with G2 acute GI toxicity (actinic proctitis). Twelve patients experienced acute G1 GU toxicity: 8/16 of men treated with MHRT and 4/8 of men treated with SBRT. Complete local control of disease was achieved in 23/24 patients (96%).

Conclusions

Our data confirm the feasibility and the low toxicity of salvage EBRT with both schedules of treatment after HIFU failure. The findings of low acute toxicity and good biochemical control rates are encouraging, but a larger number of patients and a longer follow-up are needed to confirm these results.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy

    Michele Rigo, Rosario Mazzola, Giuseppe Napoli, Niccolò Giaj-Levra, Vanessa Figlia, Luca Nicosia, Francesco Ricchetti, Francesco Cuccia & Filippo Alongi

  2. Radiation Oncology Department, University of Brescia, Brescia, Italy

    Davide Tomasini, Marco Lorenzo Bonù & Filippo Alongi

  3. Columbus Clinic Center, Milan, Italy

    Carlo Bellorofonte

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  1. Michele Rigo
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Correspondence to Michele Rigo.

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Rigo, M., Mazzola, R., Napoli, G. et al. Post-HIFU locally relapsed prostate cancer: high-dose salvage radiotherapy guided by molecular imaging. Radiol med 125, 491–499 (2020). https://doi.org/10.1007/s11547-020-01148-4

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  • DOI: https://doi.org/10.1007/s11547-020-01148-4

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