Dados do Trabalho

Título

Salvage high dose radiotherapy guided by imaging following primary high intensity focused ultrasound (HIFU) for treatment of prostate cancer: case report and literature review

Apresentação do caso

Patient, 66 years old, diagnosed with prostate adenocarcinoma on 06/2016. Initial PSA of 10.6, AP from adenocarcinoma Gleason 7 (3+4)(4f/12), MRI of pelvis with left prostate lesion. He underwent treatment with total gland HIFU after RTU on 06/2016. Patient with successive increase in PSA and in 09/2019 submitted to biopsy that showed adenocarcinoma Gleason 6. Performed MRI with prostate of 10 g and PET-PSMA with left lesion and SUV of 7 without systemic disease. Returns only in 09/2020 with a PSA of 3.3. New PET-PSMA with left central lesion with SUV DE 3 on 10/13/2020. He underwent rescue RXT with a dose of 20 of 300 cGy with IMRT VMAT technique and daily cone beam on 12/2020. Acute toxicity with grade I/II dysuria only. Control PSA of 0.74 on 01/2021 and 0.26 on 06/2021.

Discussão

Patients treated with focal therapy as the primary treatment, in relapse can be rescued with surgery, high-tech radiotherapy and even new ablation. Important limitations include the low level of evidence and the absence of randomized trials.
Rigo et al, in 2020 reported 24 patients with biochemical failure in residual prostate and rescued with a moderate hypofractionation scheme in 28 fractions (16 patients) or with an extreme hypofractionation scheme (SBRT) in 5 fractions (8 patients). In moderate hypo, the median dose was 71.4 Gy, while in SBRT it was 32.5 Gy. Average follow-up was 28 months. The mean nadir of PSA was 0.26 ng/mL and 0.15 ng/mL respectively. No higher acute or late toxicity was observed in G3. Three patients had GI and G2 acute toxicity. Twelve patients had G1 GU acute toxicity. Complete local disease control was achieved in 23/24 patients (96%). The data confirm the feasibility and low toxicity of salvage radiotherapy with both treatment regimens after HIFU failure. The findings of low acute toxicity and good rates of biochemical control are encouraging, but a larger number of patients and longer follow-up are needed to confirm these results. These are compatible with other studies in the literature on the use of radiotherapy to rescue relapse after HIFU. In this case, the treatment was very well tolerated without presenting significant toxicity with PSA control.

Comentários finais

Evidence shows acceptable results of RXT as a salvage option, however, data are retrospective. Prospective and randomized studies are needed to confirm these preliminary data.

Palavras-chave

HIFU, recurrence cancer prostate, radiotherapy