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- W3093622243 abstract "To assess efficacy and toxicity of salvage stereotactic body radiation therapy (S-SBRT) for recurrent local and locoregional prostate cancer. A prospective IRB approved clinical database was reviewed to extract a cohort of 30 consecutive patients who received re-irradiation between 2015-2018 following failure of external beam radiotherapy (n = 25) or brachytherapy (n = 5) detected by rising PSA and positive PSMA PET-CT findings. One third of these patients (n = 10) had received Androgen Deprivation Therapy (ADT) only for biochemical failure and were referred for a local salvage treatment following emergence of castrate-resistant prostate cancer (CRPC). Histologic confirmation of recurrence was obtained in 17 patients. Hydrogel spacers or endo-rectal balloons were used in 6 and 18 patients to protect the rectum. Patients were treated with full bladder. PSA failure was according to the Phoenix definition. Toxicity was reported using CTCAE v5.0, acute <3 months, late >3 months. Seventeen patients received whole-gland radiation and 13 patients focal prostate treatment to the PSMA-avid lesion. In addition, eight patients also received 25Gy in 5 fractions to PSMA-avid pelvic nodes. Median dose of S-SBRT was 5 fractions of 6.5Gy (range: 6-8Gy). Short term ADT was initiated with S-SBRT in fifteen patients. Median time from primary radiation to S-SBRT was 9 years (range: 2-20 years). Median follow-up following S-SBRT was 23 months (range: 7-71 months). Biochemical and clinical failures developed in 14 out of 30 patients (47%), of which 3 were in-field, 2 were regional and 9 developed bone metastasis, thus local control of S-SBRT to the prostate was 90%. Median time to failure was 16 months (range: 3-36 months). Failure occurred in 8 out of 10 CRPC patients versus 6 out of 20 castrate-naïve patients (80% vs 30%, p = 0.009). One patient was lost to follow-up after 12 months, thus 15 patients (50%) had no evidence of disease at a median follow-up of 19 months. Acute grade 2 GU toxicity, primarily cystitis, occurred in 8 patients (27%) and 1 patient (3%) had grade 3 hematuria. Late grade 2 GU toxicity was 27% (n = 8) and 1 patient (3%) had a grade 3 urethral stricture. There was no ≥ grade 2 acute GI toxicity. Late grade 2 GI incontinence occurred in 1 patient (3%) with no grade 3 events. One patient developed late grade 3 osteomyelitis pubis following treatment. S-SBRT is associated with favorable local control and acceptable toxicity and thus should be further studied as an early salvage option which could potentially spare toxicity of lifelong hormonal therapy. Patients with non-metastatic castrate resistant disease were more prone to rapidly develop distant metastasis following S-SBRT." @default.
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- W3093622243 date "2020-11-01" @default.
- W3093622243 modified "2023-09-25" @default.
- W3093622243 title "Re-Irradiation with Extreme Hypo-Fractionation to the Prostate for Local Recurrence after Primary Radiotherapy" @default.
- W3093622243 doi "https://doi.org/10.1016/j.ijrobp.2020.07.477" @default.
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