First Russian experience of the stereotactic radiotherapy on the prostate bed

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Abstract

Purpose. Assess the safety of postoperative radiation therapy on the area of the prostate bed (PB) using extreme dose hypofractionation (5 fractions of 6.6–7 Gy).

Materials and methods. from April 2019 to March 2020 at the National Medical Center of Oncology named after N.N. Petrov of the Ministry of Health of the Russian Federation in the first 15 patients of the prostate cancer carried out stereotactic radiation therapy (SRT) on the PB. Depending on the clinical situation, adjuvant and salvage SRT were distinguished. Linear electron accelerators with 6 MeV energy are used for treatment. Three factional regimes were evaluated: 5 factions of 6.6 Gy, 5 factions of 6.8 Gy and 5 factions of 7 Gy. The clinical target volume is defined by RTOG (2010).

Results. The median of follow-up was 7.6 (1.3-11.6) months. Of the 15 patients, adjuvant SRT performed three observed, and the remaining 12 patients – salvage SRT (4 – early, 8 – delayed). Acute radiation toxicity was estimated in 12 patients. Early impairment from the lower urinary tract 1 degree was observed in 8 (66.7%) 12 of them. Toxicity of 2 or more degree in the early period was not observed. Clinical signs of early 1st degree toxicity from the rectum were found in five (41.7%) of the bowel of the 12 observed. One patient (8.3%) there was a mixture of blood in the feces, which required a medical correction, which was considered as toxicity of the 2nd degree.

Conclusions. Postoperative SRT of the PB region is a promising modern method of radiation treatment of patients with prostate cancer. The presented methods of adjuvant and salvage SRT are feasible in clinical practice and are characterized by an acceptable level of early radiation toxicity.

About the authors

Roman V. Novikov

National Medical Center of Oncology named after N.N. Petrov of the Ministry of Health of Russian Federation; Saint Petersburg State University

Author for correspondence.
Email: novikov-spb@mail.ru

Candidate of Medical Science, Senior Researcher, Scientific Department of Radiation Oncology and Nuclear Medicine

Russian Federation, St. Petersburg

Julia S. Melnik

National Medical Center of Oncology named after N.N. Petrov of the Ministry of Health of Russian Federation

Email: juliemeln@gmail.com

Medical Physicist of Radiation Therapy Department

Russian Federation, St. Petersburg

Olga I. Ponomareva

National Medical Center of Oncology named after N.N. Petrov of the Ministry of Health of Russian Federation

Email: ponomarevaniio@rambler.ru

Radiologist of Radiation Therapy Department

Russian Federation, St. Petersburg

Sergey N. Novikov

National Medical Center of Oncology named after N.N. Petrov of the Ministry of Health of Russian Federation

Email: krokon@mail.ru

Doctor of Medical Science, Head of Radiotherapy Department, Head of Scientific Department of Radiation Oncology and Nuclear Medicine

Russian Federation, St. Petersburg

References

  1. Azhar RA, Elkoushy MA, Aldousari S. Robot-assisted urological surgery in the Middle East: Where are we and how far can we go? Arab J Urol. 2019;17(2):106-113. https://doi.org/10.1080/2090598X.2019.1601003.
  2. Ilic D, Evans SM, Allan CA, et al. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev. 2017;2017(9): CD009625. https://doi.org/10.1002/14651858.CD009625.pub2.
  3. Hamdy FC, Donovan JL, Lane JA, et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016;375(15):1415-1424. https://doi.org/10.1056/NEJMoa1606220.
  4. Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part I: Risk Stratification, Shared Decision Making, and Care Options. J Urol. 2018;199(3):683-690. https://doi.org/10.1016/j.juro.2017.11.095.
  5. Koskas Y, Lannes F, Branger N, et al. Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up. BMC Urol. 2019;19(1):37. https://doi.org/10.1186/s12894-019-0470-8.
  6. Martini A, Gandaglia G, Fossati N, et al. Defining Clinically Meaningful Positive Surgical Margins in Patients Undergoing Radical Prostatectomy for Localised Prostate Cancer. Eur Urol Oncol. 2019. https://doi.org/10.1016/j.euo.2019.03.006.
  7. Preisser F, Coxilha G, Heinze A, et al. Impact of positive surgical margin length and Gleason grade at the margin on biochemical recurrence in patients with organ-confined prostate cancer. Prostate. 2019;79(16):1832-1836. https://doi.org/10.1002/pros.23908.
  8. Orosco RK, Tapia VJ, Califano JA, et al. Positive Surgical Margins in the 10 Most Common Solid Cancers. Sci Rep. 2018;8(1):5686. https://doi.org/10.1038/s41598-018-23403-5.
  9. Mohler JL, Antonarakis ES, Armstrong AJ, et al. Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019;17(5):479-505. https://doi.org/10.6004/jnccn.2019.0023.
  10. Mottet N, van den Bergh RCN, Briers E, et al. EAU – ESTRO – ESUR – SIOG Guidelines on Prostate Cancer. European Association of Urology; 2018.
  11. Pisansky TM, Thompson IM, Valicenti RK, et al. Adjuvant and Salvage Radiotherapy after Prostatectomy: ASTRO/AUA Guideline Amendment 2018-2019. J Urol. 2019;202(3):533-538. https://doi.org/10.1097/JU.0000000000000295.
  12. Datta NR, Stutz E, Rogers S, Bodis S. Conventional Versus Hypofractionated Radiation Therapy for Localized or Locally Advanced Prostate Cancer: A Systematic Review and Meta-analysis along with Therapeutic Implications. Int J Radiat Oncol Biol Phys. 2017;99(3):573-589. https://doi.org/10.1016/j.ijrobp.2017.07.021.
  13. Picardi C, Perret I, Miralbell R, Zilli T. Hypofractionated radiotherapy for prostate cancer in the postoperative setting: What is the evidence so far? Cancer Treat Rev. 2018;62:91-96. https://doi.org/10.1016/j.ctrv.2017.11.004.
  14. Jackson WC, Silva J, Hartman HE, et al. Stereotactic Body Radiation Therapy for Localized Prostate Cancer: A Systematic Review and Meta-Analysis of Over 6,000 Patients Treated On Prospective Studies. Int J Radiat Oncol Biol Phys. 2019;104(4):778-789. https://doi.org/10.1016/j.ijrobp.2019.03.051.
  15. Tilki D, Preisser F, Graefen M, et al. External Validation of the European Association of Urology Biochemical Recurrence Risk Groups to Predict Metastasis and Mortality After Radical Prostatectomy in a European Cohort. Eur Urol. 2019;75(6):896-900. https://doi.org/10.1016/j.eururo.2019.03.016.
  16. Martino P, Scattoni V, Galosi AB, et al. Role of imaging and biopsy to assess local recurrence after definitive treatment for prostate carcinoma (surgery, radiotherapy, cryotherapy, HIFU). World J Urol. 2011;29(5):595-605. https://doi.org/10.1007/s00345-011-0687-y.
  17. Browne BM, Vanni AJ. Management of Urethral Stricture and Bladder Neck Contracture Following Primary and Salvage Treatment of Prostate Cancer. Curr Urol Rep. 2017;18(10):76. https://doi.org/10.1007/s11934-017-0729-0.
  18. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31(5): 1341-1346. https://doi.org/10.1016/0360-3016(95)00060-c.
  19. Michalski JM, Lawton C, El Naqa I, et al. Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;76(2):361-368. https://doi.org/10.1016/j.ijrobp.2009.02.006.
  20. Ascopost.com [Internet]. The ASCO Post. 2018 ASTRO: SPPORT Trial: ADT with or without pelvic lymph node radiation in prostate cancer [updated 2018 Oct 30; cited 2020 May 6]. Available from: http://www.ascopost.com/News/59414 Cited 15 March 2019.
  21. Van den Broeck T, van den Bergh RCN, Arfi N, et al. Prognostic Value of Biochemical Recurrence Following Treatment with Curative Intent for Prostate Cancer: A Systematic Review. Eur Urol. 2019;75(6): 967-987. https://doi.org/10.1016/j.eururo.2018.10.011.
  22. Bartkowiak D, Siegmann A, Bohmer D, et al. The impact of prostate-specific antigen persistence after radical prostatectomy on the efficacy of salvage radiotherapy in patients with primary N0 prostate cancer. BJU Int. 2019;124(5):785-791. https://doi.org/10.1111/bju.14851.
  23. Preisser F, Chun FKH, Pompe RS, et al. Persistent Prostate-Specific Antigen After Radical Prostatectomy and Its Impact on Oncologic Outcomes. Eur Urol. 2019;76(1):106-114. https://doi.org/10.1016/j.eururo.2019.01.048.
  24. Barbosa FG, Queiroz MA, Nunes RF, et al. Revisiting Prostate Cancer Recurrence with PSMA PET: Atlas of Typical and Atypical Patterns of Spread. Radiographics. 2019;39(1):186-212. https://doi.org/10.1148/rg.2019180079.
  25. Calais J, Czernin J, Cao M, et al. (68)Ga-PSMA-11 PET/CT Mapping of Prostate Cancer Biochemical Recurrence after Radical Prostatectomy in 270 Patients with a PSA Level of Less Than 1.0 ng/mL: Impact on Salvage Radiotherapy Planning. J Nucl Med. 2018;59(2):230-237. https://doi.org/10.2967/jnumed.117.201749.
  26. Stish BJ, Pisansky TM, Harmsen WS, et al. Improved Metastasis-Free and Survival Outcomes With Early Salvage Radiotherapy in Men With Detectable Prostate-Specific Antigen After Prostatectomy for Prostate Cancer. J Clin Oncol. 2016;34(32):3864-3871. https://doi.org/10.1200/JCO.2016.68.3425.
  27. Detti B, Bonomo P, Masi L, et al. CyberKnife stereotactic radiotherapy for isolated recurrence in the prostatic bed. World J Urol. 2016;34(3):311-317. https://doi.org/10.1007/s00345-015-1613-5.
  28. Ballas LK, Luo C, Chung E, et al. Phase 1 Trial of SBRT to the Prostate Fossa After Prostatectomy. Int J Radiat Oncol Biol Phys. 2019;104(1):50-60. https://doi.org/10.1016/j.ijrobp.2018.12.047.
  29. Sampath S, Frankel P, Vecchio BD, et al. Stereotactic Body Radiation Therapy to the Prostate Bed: Results of a Phase 1 Dose-Escalation Trial. Int J Radiat Oncol Biol Phys. 2020;106(3):537-545. https://doi.org/10.1016/j.ijrobp.2019.11.005.
  30. Francolini G, Jereczek-Fossa BA, Di Cataldo V, et al. Stereotactic radiotherapy for prostate bed recurrence after prostatectomy, a multicentric series. BJU Int. 2020;125(3):417-425. https://doi.org/10.1111/bju.14924.

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2. Fig. 1. Dosimetric support of the stereotactic radiotherapy on the prostate bed: а – example of a 3D model of a treatment plan using two dynamic arches (RapidArc); b – 3D model of irradiated prostate bed (orange) and organs at risk: bladder (yellow), rectum (dark red), femur heads (blue); c – an example of isodose distribution (coronal scan), to the left of the vesico-urethral anastomosis is visible X-ray contrast gold seed; d – clinical and planned target volumes (sagittal scan), x-rays of contrast staples used as landmarks are visible in the area of the prostate bed

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Copyright (c) 2020 Novikov R.V., Melnik J.S., Ponomareva O.I., Novikov S.N.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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