title: Robotic image-guided stereotactic radiotherapy, for isolated recurrent primary, lymph node or metastatic prostate cancer.
abstract: OBJECTIVE
  To evaluate the outcome of robotic CyberKnife (Accuray, Sunnyvale, CA)-based stereotactic radiotherapy (CBK-SRT) for isolated recurrent primary, lymph node, or metastatic prostate cancer.
  
  
  METHODS
  Between May 2007 and December 2009, 34 consecutive patients/38 lesions were treated (15 patients reirradiated for local recurrence [P], 4 patients reirradiated for anastomosis recurrence [A], 16 patients treated for single lymph node recurrence [LN], and 3 patients treated for single metastasis [M]). In all but 4 patients, [(11)C]choline positron emission tomography/computed tomography was performed. CBK-SRT consisted of reirradiation and first radiotherapy in 27 and 11 lesions, respectively. The median CBK-SRT dose was 30 Gy in 4.5 fractions (P, 30 Gy in 5 fractions; A, 30 Gy in 5 fractions; LN, 33 Gy in 3 fractions; and M, 36 Gy in 3 fractions). In 18 patients (21 lesions) androgen deprivation was added to CBK-SRT (median duration, 16.6 months).
  
  
  RESULTS
  The median follow-up was 16.9 months. Acute toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event). Late toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event and 1 Grade 2 event). Biochemical response was observed in 32 of 38 evaluable lesions. Prostate-specific antigen stabilization was seen for 4 lesions, and in 2 cases prostate-specific antigen progression was reported. The 30-month progression-free survival rate was 42.6%. Disease progression was observed for 14 lesions (5, 2, 5, and 2 in Groups P, A, LN, and M respectively). In only 3 cases, in-field progression was seen. At the time of analysis (May 2010), 19 patients are alive with no evidence of disease and 15 are alive with disease.
  
  
  CONCLUSIONS
  CyberKnife-based stereotactic radiotherapy is a feasible approach for isolated recurrent primary, lymph node, or metastatic prostate cancer, offering excellent in-field tumor control and a low toxicity profile. Further investigation is warranted to identify the patients who benefit most from this treatment modality. The optimal combination with androgen deprivation should also be defined.
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy. barbara.jereczek@ieo.it
authors.forename: Barbara Alicja
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Beltramo
authors.forename: Laura
authors.initials: L
authors.lastname: Fariselli
authors.forename: Cristiana
authors.initials: C
authors.lastname: Fodor
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoro
authors.forename: Andrea
authors.initials: A
authors.lastname: Vavassori
authors.forename: Dario
authors.initials: D
authors.lastname: Zerini
authors.forename: Federica
authors.initials: F
authors.lastname: Gherardi
authors.forename: Carmen
authors.initials: C
authors.lastname: Ascione
authors.forename: Isa
authors.initials: I
authors.lastname: Bossi-Zanetti
authors.forename: Roberta
authors.initials: R
authors.lastname: Mauro
authors.forename: Achille
authors.initials: A
authors.lastname: Bregantin
authors.forename: Livia Corinna
authors.initials: LC
authors.lastname: Bianchi
authors.forename: Ottavio
authors.initials: O
authors.lastname: De Cobelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D002250:Carbon Radioisotopes; D002794:Choline; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005270:Femur Head / Q000528:radiation effects; D057918:Fiducial Markers; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D058958:Organs at Risk / Q000528:radiation effects; D049268:Positron-Emission Tomography; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000379:methods; D012007:Rectum / Q000528:radiation effects; D019233:Retreatment / Q000379:methods; D012371:Robotics / Q000379:methods*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D014521:Urethra / Q000528:radiation effects; D001743:Urinary Bladder / Q000528:radiation effects
chemical_list: D000726:Androgen Antagonists; D002250:Carbon Radioisotopes; D017430:Prostate-Specific Antigen; D002794:Choline