EDISCIENCES

ABSTRACT

Introduction Twenty-two to 69% of patients with localized prostate cancer deve- lop local recurrence after radical therapy. Older patients require a “tailored therapy”, considering previous oncological treatments, co- morbidities and Eastern Cooperative Oncology Group Performance Status (ECOG PS). The gold standard has not been established. This analysis aimed to confirm the safety and feasibility of reirradia- tion with stereotactic body radiation therapy (SBRT) in older patien- ts with locally recurrent prostate cancer (OPCa). Materials and methods We reviewed 8 patients, aged 72-84 years, treated with salvage reir- radiation between April 2019 and October 2020. All patients have been evaluated from the multidisciplinary uro-oncology unit. Inclu- sion criteria were: biochemical failure, no distant metastatic, no pre- vious treatment-related severe residual toxicity; no other local or sy- stemic salvage treatment was permitted. All patients had 11-choline positron emission tomography (PET) with co-registered computed tomography (CT) scan, multiparametric prostate magnetic resonan- ce imaging (MRI) and whole-body MRI. The total dose of radiation delivered was 30 Gy/5 fractions (Biologically Effective Dose ≥ 130 Gy). Outcomes were biochemical progression-free survival, acute and late toxicity, quality of life. The quality of life (QoL) was studied by the Italian version of the UCLA-PCI (University of California-Los Angeles – Prostate Cancer Index) questionnaire. The genitourinary and gastrointestinal toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG)/European Organisation for Research and Treatment of Cancer (EORTC) score. The PSA value and toxicity was recorded before the beginning of the re-irradiation and, thereafter, after 3, 6, 9, 12 and 18 months from the end of reirradiation. Results Local control at 18 months was 100%. Three patients had G1-G2 genitourinary toxicity, after 3 months from the end of stereotactic therapy: one patient had sporadic macroscopic haematuria, one patient nycturia and one patient dysuria. No late G3 genitourinary and gastrointestinal toxicity were reported. No worsening QoL was recorded in any patient. Conclusion SBRT with linear accelerator (LINAC) is a safe, feasible and non- invasive salvage treatment in older patients. In our series, salvage SBRT delayed systemic therapies by achieving and maintaining a biochemical response lasting 18 months from the end of reirradiation. KEYWORDS Older, recurrence prostate, cancer, reirradiation, linac.