Dados do Trabalho

Título

Stereotactic re-irradiation for local recurrence in the prostatic bed after prostatectomy: case report and literature review

Apresentação do caso

In our institution, from 03/04/2020 to 12/21/2020, 5 patients underwent SBRT in prostatic bed to recurrence after radical prostatectomy (PR) and radiotherapy (RXT). Recurrence in these patients was confirmed by PET-PSMA, MRI and PSA evolution. Treated with the SBRT technique with fractionation of 5 of 6.5 Gy in the tumor bed on alternate days with daily cone beam in linear accelerator. Regarding acute toxicities, it was observed that 1 patient had two episodes of self-limited rectal bleeding, 2 had temporary urinary incontinence and 1 had urethral bleeding with improvement with the use of dexamethasone.

Discussão

The treatment of prostate cancer recurrence after RXT and PR is not well established and there is no consensus on the most appropriate treatment option. Re-irradiation has already been explored in different locations with varied results and low toxicity. Advances in treatment planning, compliance and accuracy, due to image guidance, SBRT has become a safe re-irradiation option in relapsed prostate bed. The San Raffaele Institute in Milan has shown promising initial results with 30 Gy in 5 fractions. Three of the 6 patients had clinical progression, but all occurred outside the prostate. No major genitourinary or gastrointestinal morbidity was observed. Chéhange et al, reported preliminary results in 6 patients treated with Cyberknife SBRT (30Gy/5 fractions/5 consecutive days). This study was updated by Jereczek-Fossa et al: a complete response was obtained in 6 of 9 patients (no systemic therapy) with a low toxicity profile. The authors concluded that re-irradiation with CyberKnife is a viable and safe approach. D Zerini et al, was a retrospective study, between February 2008 and October 2013, that evaluated 32 patients undergoing prostatic pocket re-irradiation using SBRT with selective technologies (stereotaxic RT including CyberKnife and image guidance and intensity-modulated RT). In a follow-up of 21.3 months after re-irradiation, he observed that 13 patients were cancer-free, 3 were alive with biochemical recurrence, and 12 were alive with clinically evident disease.

Comentários finais

Prostate bed re-irradiation, using modern technology, is a viable approach for the treatment of local recurrence of prostate cancer after RXT and PR. Toxicity is usually well tolerated, however prospective studies are needed to identify late toxicities.

Palavras-chave

reirradiation, SBRT, prostate cancer, bed recurrence