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S717
ESTRO 36 2017
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robotic SBRT for exclusive local failure after primary
EBRT.
Material and Methods
Data from 28 patients treated at our Institution from
September 2012 to December 2015 with rSBRT for
prostate cancer recurrence after definitive EBRT were
retrospectively reviewed. Local intraprostatic recurrence
was assessed by
18
F-choline positron emission tomography–
computed tomography (PET); a dose of 30 Gy was
delivered in 5 fractions. PSA was assessed at 2 months, 6
months, and every 3 months following rSBRT. Toxicity was
assessed by the Common Terminology Criteria for Adverse
Events toxicity scale (CTCAE v.4.03).
Results
Patients were stratified in low (5, 17.9%), intermediate (9,
32.1%) and high risk group (14, 50.0 %) at diagnosis. Median
patient age at rSBRT was 78.5 (62-86) years. All patients
received prior EBRT for a median total dose of 76 Gy (62-
80 Gy) in 2 (1.8-3.1) Gy/fraction. Median time from
primary treatment to relapse was 74.1 (19.3-149.2)
months. Five patients were receiving androgen
deprivation (AD) following prior biochemical failure;
median pre-treatment PSA value was 2.7 (2.1-14.4) ng/ml.
Twenty-five patients showed biochemical response to
treatment at 2 and 6 months, median PSA decline -54.0%
(2.2-95.0) and -76.0% (35.9-95.0%) respectively; three
patients experienced early PSA progression at 2 and
6 months, median PSA elevation
+112.3% (20.0-204.
5%)
and +267.0% (41.9-309.1%), respectively. At the time of
our analysis, after a median follow-up of 20.9 (6.3-49.2)
months, 10 patients showed no evidence of disease, 2
patients pursued AD with stable PSA levels, while 10
patients experienced biochemical relapse; among them,
metastatic recurrence occurred in 4 cases. Biochemical
Progression-Free Survival (bPFS) was 96.4% and 75.0% at
12 and 18 months, respectively. Rectal and bladder acute
toxicity grade 1-2 was found in 4 and 1 cases, respectively
; grade 1-2 late rectal and bladder toxicity occurred in 1
and 7 cases, respectively. One patient experienced both
grade 3 acute and chronic bladder toxicity, consisting of
acute urinary retention and hematuria respectively. At
univariate and multivariate analysis of pre-treatment
variables, impaired bPFS was correlated only with high risk
category at diagnosis (HR:13.06, p=0.021). No predictive
factor for improved bPFS was found at subset analysis in
responding patients, though a trend was observed for PSA
decline at 6 months >76.0% (p=0.06).
Conclusion
Focal rSBRT can achieve long-lasting remission and delay
initiation of medical treatment,in particular in
low/intermediate risk patients at diagnosis, with
acceptable incidence of acute and late toxicity.
EP-1352 Single-fraction stereotactic body
radiotherapy for nodal oligorecurrent prostate cancer
M. Loi
1
, G. Simontacchi
2
, B. Detti
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
, C. Becherini
2
, C. Delli Paoli
2
, R.
Grassi
2
, M. Lo Russo
2
, I. Meattini
2
, S. Scoccianti
2
, M.
Mangoni
2
, L. Livi
2
1
Azienda Ospedaliera Universitaria Careggi,
Radiotherapy Unit, Firenze, Italy
2
University of Florence, Radiotherapy Department,
Florence, Italy
3
IFCA, Radiotherapy Department, Florence, Italy
Purpose or Objective
Advances in metabolic imaging allows the detection of
oligorecurrent nodal disease in prostate cancer patients
after primary surgical or radiation treatment (RT): focal
nodal stereotactic RT could be proposed in order to treat
the site of recurrence. The aim of the study is to evaluate
efficacy and toxicity of single fraction robotic stereotactic
radiation therapy (rSBRT) for isolated nodal failure in
prostate cancer patients
Material and Methods
Twenty-three prostate cancer patients with 27 isolated
nodal recurrence were treated by single fraction rSBRT
between April 2012 and March 2016. Lymphnodal disease
was assessed by
18
F-choline positron emission tomography–
computed tomography (
18
F-chol-PET); all patients
received single fraction rSBRT. PSA was assessed at 3
months and every 3 months following treatment. Toxicity
was assessed by the Common Terminology Criteria for
Adverse Events toxicity scale (CTCAE v.4.03).
Results
Median patient age at rSBRT was 75 (54-85) years. All
patients underwent definitive RT (2, 8.7%) or surgery (21,
91.3%) as primary treatment to the prostate; among
operated patients, RT was administered as an adjuvant or
salvage treatment in 3 (13.0%) and 3 (13.0%) patients
respectively. Median time from primary treatment to
relapse was 69.5 (7.6-205.4) months; median pre-
treatment PSA value was 2.13 ng/ml (0,35-19.9). Five
patients (21.7%) were receiving endocrine therapy (ET) for
at least 6 months following prior biochemical failure (BF).
Nodal sites of disease were pelvic and lumboaortic nodes
in 22 (81.4%) and 5 (18.6%) cases, respectively;four
patients were simultaneously treated on a synchronous
nodal relapse. Median dose was 24 (20-24) Gy. At 3
months, 12 (52.2%) patients showed biochemical response
(median decline -64.6%, 0.8-97.8); 11 (47.8%) patients
experienced early PSA progression (median elevation
+30.8%, 2.9-390.9). At the time of our analysis, after a
median follow-up of 13.6 months (6.0-47.8), 8 patients
showed no evidence of disease, 2 patients were continuing
ET with stable PSA levels, while 13 patients experienced
biochemical progression: among them, 7 patients started
ET for
18
F-chol-PET-negative disease, 2 patients had nodal
relapse on non-irradiated site and 4 patients developed
distant metastasis. At statistical analysis, median time to
BF was 10.0 months. Overall Biochemical Relapse-Free
Survival (bPFS) was 56.5% at 6 months and 47.8% at 12
months; no predictive factor was related to bPFS. Subset
analysis in responding patients showed a median time to
BF of 14.7 months; PSA level >4.0 ng/ml showed a
borderline predictive value for BF (p=0.054). Grade1
bladder toxicity was reported in one case.
Conclusion
Isolated nodal relapse of prostate cancer can be safely
treated by single fraction rSBRT with excellent tolerance
and promising biochemical control; careful selection of
patients is mandatory to avoid unnecessary treatment of
patient with undetectable advanced disease.
EP-1353 Salvage hypofractionated radiotherapy for
prostate cancer: acute toxicity
S. Saldi
1
, R. Bellavita
2
, I. Palumbo
3
, C. Mariucci
1
, E.
Arena
1
, M. Lupattelli
2
, A. Podlesko
1
, S. Russo
2
, R.
Dottorini
2
, V. Bini
4
, C. Aristei
3
1
University of Perugia, Radiation Oncology Section,
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 the preliminary outcome of
hypofractionated salvage radiotherapy (Hypo-SRT) with
helical tomotherapy after radical prostatectomy (RP).
Material and Methods
From March 2013 to July 2016, 58 patients underwent
Hypo-SRT for biochemical (BR) or local recurrence (LR)
after radical prostatectomy (PR). Median age was 67 years
(range 52-84). The surgical Gleason score was : <7 in 24
patients (41%), 7 in 22 (38%), >7 in 12 (21%); median PSA
pre-SRT was 0.258 ng/ml (range: 0.2-8.65). RT