Interim Results of a Prospective Prostate-Specific Membrane Antigen-Directed Focal Stereotactic Reirradiation Trial for Locally Recurrent Prostate Cancer.

Published on Jul 11, 2020in International Journal of Radiation Oncology Biology Physics5.859
· DOI :10.1016/J.IJROBP.2020.07.014
Sarah Bergamin4
Estimated H-index: 4
(USYD: University of Sydney),
Thomas Eade27
Estimated H-index: 27
(USYD: University of Sydney)
+ 9 AuthorsGeorge Hruby26
Estimated H-index: 26
(USYD: University of Sydney)
Abstract Purpose To report the feasibility, toxicity, and preliminary outcomes (metabolic and biochemical) of 68Ga-PSMA PET/CT directed focal prostate re-irradiation using linear accelerator (LINAC) based stereotactic body radiation treatment (SBRT). Methods and Materials From March 2016 to March 2019 25 patients were enrolled in a prospective single institution trial (XXX). Eligibility criteria included patients with biopsy proven isolated prostate recurrence following definitive irradiation, with concordant multi-parametric MRI and 68Ga-PSMA PET/CT findings, and a PSA of less than 15ng/mL at the time of recurrence. The study included a sequential dose escalation component with the first 18 patients receiving 36Gy in 6 fractions on alternate days with subsequent patients receiving 38Gy in 6 fractions assuming acceptable toxicity. Results Median age was 72 years (range 62-83) with a median time between first RT and salvage SBRT of 8.3 years (range 4.5- 13.6 years). Median PSA at re-irradiation was 4.1 (range 1.1 to 16.6). The median follow-up was 25 months (range 13-46 months). Acute grade 1 and 2 genitourinary (GU) toxicity occurred in 6 (24%) and 1 (4%) men respectively. Acute grade 1 gastrointestinal (GI) toxicity occurred in 8% with one acute grade 3 GI toxicity (4%) due to a rectal ulcer overlying the hydrogel. Late grade 1 and 2 GU toxicity occurred in 28% and 4%. Late grade 1 GI toxicity occurred in 8% with no grade 2 or greater toxicity. Twenty-four patients have undergone per-protocol 12 month 68Ga-PSMA PET/CT, of which 23 (92%) demonstrated a complete metabolic response. Biochemical freedom from failure was 80% at 2 years with 3/4 of the biochemical failures exhibiting recurrent local disease. Conclusions PSMA-directed salvage focal re-irradiation to the prostate using LINAC-based SBRT is feasible and safe. Toxicity was low, with very favourable short term local and biochemical control in a carefully selected cohort of patients.
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