Robotic image-guided stereotactic radiotherapy, for isolated recurrent primary, lymph node or metastatic prostate cancer

Autor: Roberto Orecchia, I. Bossi-Zanetti, Dario Zerini, Carmen Ascione, Giancarlo Beltramo, Luigi Santoro, L.C. Bianchi, Laura Fariselli, Federica Gherardi, Ottavio De Cobelli, Andrea Vavassori, Barbara Alicja Jereczek-Fossa, Roberta Mauro, Achille Bregantin, Cristiana Fodor
Rok vydání: 2010
Předmět:
Male
Organs at Risk
Cancer Research
medicine.medical_treatment
Multimodal Imaging
Metastasis
Choline
Prostate cancer
Prostate
Carbon Radioisotopes
Lymph node
Aged
80 and over
Radiation
Femur Head
Radiotherapy Dosage
Robotics
Middle Aged
Tumor Burden
medicine.anatomical_structure
Oncology
Lymphatic Metastasis
Retreatment
Radiology
medicine.medical_specialty
Urinary Bladder
Rectum
Radiosurgery
Disease-Free Survival
Urethra
Cyberknife
Fiducial Markers
medicine
Humans
Radiology
Nuclear Medicine and imaging
Survival rate
Aged
business.industry
Prostatic Neoplasms
Androgen Antagonists
Prostate-Specific Antigen
medicine.disease
Surgery
Radiation therapy
Positron-Emission Tomography
Feasibility Studies
Lymph Nodes
Neoplasm Recurrence
Local
business
Tomography
X-Ray Computed
Radiotherapy
Image-Guided
Zdroj: International journal of radiation oncology, biology, physics. 82(2)
ISSN: 1879-355X
Popis: Purpose To evaluate the outcome of robotic CyberKnife (Accuray, Sunnyvale, CA)–based 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.
Databáze: OpenAIRE
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