title: Reirradiation of Prostate Cancer Local Failures After Previous Curative Radiation Therapy: Long-Term Outcome and Tolerance.
abstract: To evaluate the safety, feasibility, side-effect profile, and proof of concept of external beam radiation therapy (EBRT) with or without a brachytherapy (BT) boost for salvage of exclusive local failure after primary EBRT for prostate cancer.
  
  
  
  Fourteen patients with presumed exclusive local recurrence after primary EBRT with or without BT were considered eligible for reirradiation. The median normalized total dose in 2-Gy fractions (NTD2Gy, α/β ratio = 1.5 Gy) was 74 Gy (range, 66-98.4 Gy) at first irradiation. Median time between the first irradiation and the reirradiation was 6.1 years (range, 4.7-10.2 years).
  
  
  
  Between 2003 and 2008 salvage treatment was delivered with a median NTD2Gy of 85.1 Gy (range, 70-93.4) to the prostate with EBRT with (n=10) or without (n=4) BT. Androgen deprivation was given to 12 patients (median time of 12 months). No grade ≥3 toxicity was observed during and within 6 weeks after RT. After a median follow-up of 94 months (range, 48-172 months) after salvage RT, 5-year grade ≥3 genitourinary and gastrointestinal toxicity-free survival figures were 77.9% ± 11.3% and 57.1% ± 13.2%, respectively. Four patients presented with combined grade 4 genitourinary/gastrointestinal toxicity. The 5-year biochemical relapse-free, local relapse-free, distant metastasis-free, and cancer-specific survival rates were 35.7% ± 12.8%, 50.0% ± 13.4%, 85.7% ± 9.4%, and 100%, respectively.
  
  
  
  Salvage whole-gland reirradiation for patients with a suspicion of exclusive local recurrence after initial RT may be associated with a high rate of severe radiation-induced side effects and poor long-term biochemical and local control.
authors.affiliation: Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland. Electronic address: Thomas.Zilli@hcuge.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zilli
authors.affiliation: Faculty of Medicine, Geneva University, Geneva, Switzerland.
authors.forename: Eileen
authors.initials: E
authors.lastname: Benz
authors.affiliation: Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Dipasquale
authors.affiliation: Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Rouzaud
authors.affiliation: Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland.
authors.forename: Raymond
authors.initials: R
authors.lastname: Miralbell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000532:radiotherapy*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000401:mortality*; D000069475:Re-Irradiation / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000401:mortality; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome