732 / 1082
S716
ESTRO 36 2017
_______________________________________________________________________________________________
Perugia, Italy
2
Perugia General Hospital, Radiation Oncology Section,
Perugia, Italy
3
University of Perugia and Perugia General Hospital,
Radiation Oncology Section, Perugia, Italy
4
Perugia General Hospital, Internal Medicine Endocrin
and Metabolic Sciences Section, Perugia, Italy
Purpose or Objective
To
evaluate
acute
toxicity
and
preliminary outcome of hypofractionated adjuvant
radiotherapy (Hypo-ART) with helical tomotherapy after
radical prostatectomy (RP).
Material and Methods
From February 2014 to July 2016, 30 prostate cancer
patients received Hypo-ART for pT2-3 N0-1 and/or
R1disease. Median age was 67 years (range 53-74). The
surgical Gleason score was: <7 in 8 patients (27%), 7 in 10
(33%) and >7 in 12 (40%). Before RP the median PSA was
7.74 (range: 1.13-44.48) which dropped to 0.025 ng/ml
(range: 0 -0.53) before Hypo-ART. RT schedule: all 30
patients received 2.25 Gy in 29 fractions (total dose: 65.25
Gy) to the prostate/seminal vesicle bed; 15 (50%)
patients also received 1.8 Gy in 29 fractions to the pelvic
lymph nodes (total dose: 52.2 Gy). A simultaneous
integrated boost (SIB) technique was used. Hormone
therapy (LHRH analogue and/or anti-androgen) was
administered to 15 (50%) patients with high risk features.
Toxicity was graded according to the Common
Terminology Criteria for Adverse Events version v4.0.
Biochemical failure was defined by ASTRO criteria. The
Kaplan-Meier method determined time-to-acute toxicity
events. The Mann-Whitney tested compared clinical and
dosimetric variables in groups with and without acute
toxicity.
Results
Median follow-up was 26.5 months (range: 3-31). The
median duration of HT was 21 months (range 4-33). Only
G1-G2 acute genitourinary (GU) and intestinal (GI)
toxicities occurred. Acute grade 1 GU toxicity occurred in
14/30 patients (56%), with 13 (43%) developing cystitis and
1 (3%) hematuria. Acute grade 2 GU toxicity (cystitis)
developed in 3/30 (10%) patients, with 1 also affected by
urinary retension (3%). Acute grade 1 GI toxicity (proctitis)
occurred in 14/30 patients (47%), which was associated
with rectal bleeding in 2 (7%) and diarrhoea in 5 (17%).
Acute grade 2 GI toxicity (proctitis) developed in 3/30
(10%) patients, which was associated with rectal bleeding
in 1 (3%) and diarrhoea in 1 (3%). Post Hypo-ART the
median PSA was 0.01 ng/ml (range:0-0.22) and the nadir
was 0.005 ng/ml (range: 0-0.2). At the last follow-up
no patient presented evidence of biochemical or loco-
regional recurrence. The probability of developing acute
GU on day 44 and GI toxicity on day 43 was 50% (95% CI 41-
46; 95% CI 39-46 respectively ). No differences emerged in
clinical and dosimetric variables in group with or without
acute toxicity.
Conclusion
These results suggest that moderate Hypo -ART is safe,
effective and well-tolerated. A longer follow-up is needed
to assess late toxicity and disease-free survival.
EP-1350 Stereotactic re-irradiation for prostate cancer
recurrence after upfront surgery and radiotherapy
V. Di Cataldo
1
, G. Simontacchi
2
, B. Detti
2
, M. Loi
2
, P.
Bonomo
2
, L. Masi
1
, R. Doro
1
, I. Bonucci
1
, S. Cipressi
1
, D.
Greto
2
, M. Mangoni
2
, I. Desideri
2
, I. Meattini
2
, S.
Scoccianti
2
, E. Olmetto
2
, C. Muntoni
2
, G.A. Carta
2
, L. Livi
2
1
IFCA, Department of Radiotherapy, Firenze, Italy
2
University of Florence, Radiation Therapy Department,
Florence, Italy
Purpose or Objective
Recurrence of prostatic cancer after radical
prostatectomy and external-beam radiation therapy
(EBRT) is a common occurrence in daily clinical practice.
We present our experience of re-irradiation with robotic
stereotactic body radiation therapy (rSBRT) for isolated
recurrence in the prostatic bed from prostate cancer
previously treated with surgery and radiation therapy.
Material and Methods
Between June 2012 and February 2016, rSBRT was
administered for isolated local relapse to 22 patients
previously treated with prostatectomy and adjuvant (9,
40.1%) or salvage (13, 59.9%) EBRT. After primary
treatment, all patients experienced a biochemical
recurrence with an isolated relapse in the prostatic bed
diagnosed with 18F-choline positron emission tomography–
computed tomography (PET) with or without pelvic
magnetic resonance (MRI). The gross tumor volume (GTV)
was defined on the basis of clinical and radiological
findings by image fusion of PET and/or MRI. The total dose
was 30 Gy in 5 fractions prescribed to the 80% isodose line.
PSA was assessed at 2, 6 and every 3 months, following
rSBRT. Toxicity was assessed by the Common Terminology
Criteria for Adverse Events toxicity scale (CTCAE v.4.03).
Results
Twenty-two patients were treated and followed for a
median time of 19.5 months (range: 59,4-74.0 months).
Prior EBRT had a median total dose of 68 Gy (range 59,4-
74.0 Gy ) in 1,8-2 Gy for fraction. Median time from EBRT
to relapse was 73,3 months (range: 16,9-203.1). Seven
patients were receiving androgen deprivation therapy
(ADT) following prior biochemical failure; median pre-re-
irradiation PSA value was 1.9 ng/ml (0,4-30). Eighteen
patients had biochemical response at 2 and 6 months, with
a median PSA decrease of 44,9% and 64,9% respectively;
four patients experienced early PSA progression at 2 and
6 months, the median PSA rise was 85,1% and 228,6%
respectively. At the time of our analysis, 10 patients
showed no evidence of disease, in 2 patients an hormonal
treatment was continued with stable PSA levels, while 10
patients had biochemical relapse and four of these had
metastatic disease. Biological Progression-free Survival
(bPFS) was 81.8% and 68.2% at 6 and 12 months,
respectively. Treatment was well tolerated, genitourinary
acute and late G1-G2 toxicity occurred in 6 and 5 patients
respectively, while two patients experienced late rectal
G1-G2 toxicity. At univariate and multivariate analysis of
pre-treatment variables, impaired biochemical relapse-
free survival (BRFS) was correlated with the use of ADT at
the moment of the treatment (p=0.013). Subset analysis
in responding patients did not found predictor of BRFS.
Conclusion
RSBRT for isolated recurrence in the prostatic bed from
prostate cancer previously treated with prostatectomy
and EBRT showed favourable results in biochemical control
with low and acceptable toxicity, however further
prospective studies are needed to confirm these results.
EP-1351 Stereotactic radiotherapy in recurrent
prostate cancer previously treated by radical irradiation
M. Loi
1
, B. Detti
2
, G. Simontacchi
2
, V. Di Cataldo
3
, P.
Bonomo
2
, L. Masi
3
, R. Doro
3
, I. Bonucci
3
, S. Cipressi
3
, I.
Desideri
2
, D. Greto
2
, M. Perna
2
, V. Carfora
2
, G.
Francolini
2
, I. Meattini
2
, M. Mangoni
2
, S. Scoccianti
2
, L.
Livi
2
1
Azienda Ospedaliera Universitaria Careggi,
Radiotherapy Unit, Firenze, Italy
2
Universita degli Studi di Firenze, Radiotherapy
Department, Florence, Italy
3
IFCA, Radiotherapy Department, Florence, Italy
Purpose or Objective
Biochemical recurrence can occur following definitive
external beam radiation therapy (EBRT) for localized
prostate cancer. Focal robotic stereotactic body
radiotherapy (rSBRT) to the recurrent intraprostatic tumor
is emerging as a valuable option in this setting. In this
retrospective study we evaluated efficacy and toxicity of