Robotic Image-Guided Stereotactic Radiotherapy, for Isolated Recurrent Primary, Lymph Node or Metastatic Prostate Cancer

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• 作者：Barbara Alicja Jereczek-Fossa ; M.D. ; Ph.D.^&lowast ; ; ^&dagger ; ; ^{barbara.jereczek@ieo.it} ; Giancarlo Beltramo ; M.D.^&Dagger ; ; Laura Fariselli ; M.D.^§ ; ; Cristiana Fodor ; M.Sc.^&lowast ; ; Luigi Santoro ; M.Sc.^?/sup> ; Andrea Vavassori ; M.D.^&lowast ; ; Dario Zerini ; M.D.^&lowast ; ; Federica Gherardi ; M.D.^&lowast ; ; ^&dagger ; ; Carmen Ascione ; M.D.^&lowast ; ; ^¶ ; ; Isa Bossi-Zanetti ; M.D.^&lowast ; ; ^&dagger ; ; Roberta Mauro ; M.D.^&lowast ; ; ^&dagger ; ; Achille Bregantin ; M.Sc.^&Dagger ; ; Livia Corinna Bianchi ; M.D.^&Dagger ; ; Ottavio De Cobelli ; M.D.^# ; Roberto Orecchia ; M.D.^&lowast ; ; ^&dagger ;
• 关键词：Recurrent prostate cancer ; Lymph node recurrence ; Stereotactic radiotherapy ; Robotic stereotactic radiotherapy
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 出版时间：1 February 2012
• 年：2012
• 卷：82
• 期：2
• 页码：889-897
• 全文大小：168 K

文摘

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Purpose

To evaluate the outcome of robotic CyberKnife (Accuray, Sunnyvale, CA)¨Cbased stereotactic radiotherapy (CBK-SRT) for isolated recurrent primary, lymph node, or metastatic prostate cancer.

Methods and Materials

Between May 2007 and December 2009, 34 consecutive patients/38 lesions were treated (15 patients reirradiated for local recurrence [P], 4 patients reirradiated for anastomosis recurrence [A], 16 patients treated for single lymph node recurrence [LN], and 3 patients treated for single metastasis [M]). In all but 4 patients, [¹¹C]choline positron emission tomography/computed tomography was performed. CBK-SRT consisted of reirradiation and first radiotherapy in 27 and 11 lesions, respectively. The median CBK-SRT dose was 30 Gy in 4.5 fractions (P, 30 Gy in 5 fractions; A, 30 Gy in 5 fractions; LN, 33 Gy in 3 fractions; and M, 36 Gy in 3 fractions). In 18 patients (21 lesions) androgen deprivation was added to CBK-SRT (median duration, 16.6 months).

Results

The median follow-up was 16.9 months. Acute toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event). Late toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event and 1 Grade 2 event). Biochemical response was observed in 32 of 38 evaluable lesions. Prostate-specific antigen stabilization was seen for 4 lesions, and in 2 cases prostate-specific antigen progression was reported. The 30-month progression-free survival rate was 42.6 % . Disease progression was observed for 14 lesions (5, 2, 5, and 2 in Groups P, A, LN, and M respectively). In only 3 cases, in-field progression was seen. At the time of analysis (May 2010), 19 patients are alive with no evidence of disease and 15 are alive with disease.

Conclusions

CyberKnife-based stereotactic radiotherapy is a feasible approach for isolated recurrent primary, lymph node, or metastatic prostate cancer, offering excellent in-field tumor control and a low toxicity profile. Further investigation is warranted to identify the patients who benefit most from this treatment modality. The optimal combination with androgen deprivation should also be defined.