title: Salvage reirradiation for locoregional failure after radiation therapy for prostate cancer: who, when, where and how?
abstract: Even in the current era of dose-escalated radiotherapy for prostate cancer, biochemical recurrence is not uncommon. Furthermore, biochemical failure is not specific to the site of recurrence. One of the major challenges in the management of prostate cancer patients with biochemical failure after radiotherapy is the early discrimination between those with locoregional recurrence only and those with metastatic disease. While the latter are generally considered incurable, patients with locoregional disease may benefit from emerging treatment options. Ultimately, the objective of salvage therapy is to control disease while ensuring minimal collateral damage, thereby optimizing both cancer and toxicity outcomes. Advances in functional imaging, including multiparametric prostate MRI, abdominopelvic lymphangio-MRI, sentinel node SPECT-CT and/or whole-body PET/CT have paved the way for salvage radiotherapy in patients with local recurrence, microscopic nodal disease limited to the pelvis or oligometastatic disease. These patients may be considered for salvage reirradiation using different techniques: prostate low-dose or high-dose rate brachytherapy, pelvic and/or lomboaortic image-guided radiotherapy with elective nodal irradiation, focal nodal or bone stereotactic body radiation therapy (SBRT). An individualized approach is recommended. The decision about which treatment, if any, to use will be based on the initial characteristics of the disease, relapse patterns and the natural history of the rising prostate specific antigen (PSA). Preliminary results suggest that more than 50% of patients who have undergone salvage reirradiation are biochemically relapse-free with very low rates of severe toxicity. Large prospective studies with a longer follow-up are needed to confirm the promising benefit/risk ratio observed with salvage brachytherapy and or salvage nodal radiotherapy and/or bone oligometastatic SBRT when compared with life-long palliative hormones.
authors.affiliation: Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France; Laboratoire d'électronique et d'informatique de l'image (Le2i), CNRS Unité 6306, Université de Bourgogne, BP 27877, 21078 Dijon cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Créhange
authors.affiliation: Department of Radiation Oncology, Helen Diller Comprehensive Cancer Center, UCSF, San Francisco, California, United States; Department of Urology, Helen Diller Comprehensive Cancer Center, UCSF, San Francisco, California, United States.
authors.forename: M
authors.initials: M
authors.lastname: Roach
authors.affiliation: Département d'oncologie radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France.
authors.forename: E
authors.initials: E
authors.lastname: Martin
authors.affiliation: Département d'urologie, hôpital Le Bocage, CHU de Dijon, 14, rue Paul-Gaffarel, 21079 Dijon, France.
authors.forename: L
authors.initials: L
authors.lastname: Cormier
authors.affiliation: Département de radiothérapie oncologie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France.
authors.forename: D
authors.initials: D
authors.lastname: Peiffert
authors.affiliation: Laboratoire d'électronique et d'informatique de l'image (Le2i), CNRS Unité 6306, Université de Bourgogne, BP 27877, 21078 Dijon cedex, France; Département de médecine nucléaire, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France; Département de RMN spectroscopie, hôpital Le Bocage, CHU de Dijon, 14, rue Paul-Gaffarel, 21079 Dijon, France.
authors.forename: A
authors.initials: A
authors.lastname: Cochet
authors.affiliation: Département de radiothérapie oncologie, CHU Lyon Sud, 165, chemin du Grand-Revoyet, Pierre-Bénite, France.
authors.forename: O
authors.initials: O
authors.lastname: Chapet
authors.affiliation: Département de radiothérapie oncologie, institut de cancérologie de l'Ouest René-Gauducheau, 44805 Saint-Herblain cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Supiot
authors.affiliation: Département de radiothérapie oncologie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Cosset
authors.affiliation: Département de radiothérapie oncologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: M
authors.initials: M
authors.lastname: Bolla
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto M4N 3M5, Ontario, Canada. Electronic address: hans.chung@sunnybrook.ca.
authors.forename: H T
authors.initials: HT
authors.lastname: Chung
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D001918:Brachytherapy; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D006801:Humans; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008297:Male; D015337:Multicenter Studies as Topic; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy; D010166:Palliative Care; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D011786:Quality Control; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen
keywords: Cancer de prostate; Curiethérapie de rattrapage; Local failure; Oligometastases; Oligométastases; Prostate cancer; Radiothérapie de rattrapage; Rechute locale; Salvage brachytherapy; Salvage radiotherapy