SSRT approach is based on a tailored treatment volume targeted on macroscopic evidence of prostate bed relapse. Reducing the treatment volume allowed to avoid the whole prostate bed and to spare unnecessary irradiation of elective volumes. Thus, SSRT may improve the therapeutic ratio of prostate bed radiotherapy despite the hypofractionated regimen (35 Gy in 5 fractions). Of note, a tailored approach based on metabolic imaging in patients affected by postoperative recurrence is the object of PSICHE trial (NCT05022914), an observational study currently enrolling patients in our department. In PSICHE trial, all patients affected by biochemical relapse after surgery for prostate cancer (PSA >0.2 < 1 ng/ml) undergo staging through Prostate Specific Membrane Antigen (PSMA) PET/CT and following radiotherapy management is based on a pre-defined algorithm. Patients with negative PSMA findings are treated with conventional SRT, while patients with positive findings within prostate bed are treated with SSRT on macroscopic local relapse. At the same time, all patients with regional or distant disease are treated with stereotactic radiotherapy if < 3 lesions are detected, while systemic treatment (androgen deprivation therapy +/- Androgen targeted agents) is administered in case of polimetastatic disease (>3 lesions detected).
Elective treatment volumes (e.g prostate bed or whole pelvic radiotherapy), were the cornerstone for treatment in the last decades, due to the unavailability of novel imaging methods allowing early detection of disease localisation. In our opinion, ultra-sensitive imaging will allow the implementation of a tailored treatment approach in this scenario, avoiding to use large prophylactic treatment volumes and exploiting the whole potentiality of metastasis directed therapy.
Written by: Giulio Francolini, Barbara Alicja Jereczek-Fossa, Vanessa Di Cataldo, Gabriele Simontacchi, Giulia Marvaso, Sara Gandini, Federica Corso, Lucia Pia Ciccone, Maria Alessia Zerella, Piercarlo Gentile, Federico Bianciardi, Sara Allegretta, Beatrice Detti, Isacco Desideri, Rolando Maria D'Angelillo, Laura Masi, Gianluca Ingrosso, Mario Di Staso, Ercole Mazzeo, Fabio Trippa, Frank Lohr, Alessio Bruni, Lorenzo Livi
Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy., Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy., Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy., Department of Experimental Oncology, European Institute of Oncology IRCCS, Via Adamello 16, 20139, Milan, Italy., Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy., UPMC San Pietro FBF, Rome, Italy., Department of Radiation Oncology, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy., Department of Medical Physics and Radiation Oncology, IFCA, 50139, Florence, Italy., Radiation Oncology Section, Department of Medicine and Surgery, Perugia General Hospital, University of Perugia, Perugia, Italy., Radiotherapy Unit, "Nuovo San Salvatore" Hospital, L'Aquila, Italy., Radiotherapy Unit, University Hospital of Modena, Modena, Italy., Radiotherapy Oncology Centre, Azienda Ospedaliera S. Maria, Terni, Italy.
References:
- Francolini, G., Jereczek-Fossa, B. A., Di Cataldo, V., Simontacchi, G., Marvaso, G., Zerella, M. A., Gentile, P., Bianciardi, F., Allegretta, S., Detti, B., Masi, L., Lo Russo, M., & Livi, L. (2020). Stereotactic radiotherapy for prostate bed recurrence after prostatectomy, a multicentric series. BJU international, 125(3), 417–425.