title: Salvage Stereotactic Body Radiotherapy for Isolated Lymph Node Recurrent Prostate Cancer: Single Institution Series of 94 Consecutive Patients and 124 Lymph Nodes.
abstract: The purpose of the study was to evaluate the prostate serum antigen (PSA) response, local control, progression-free survival (PFS), and toxicity of stereotactic body radiotherapy (SBRT) for lymph node (LN) oligorecurrent prostate cancer.
  
  
  
  Between May 2012 and October 2015, 124 lesions were treated in 94 patients with a median dose of 24 Gy in 3 fractions. Seventy patients were treated for a single lesion and 25 for > 1 lesion. In 34 patients androgen deprivation (AD) was combined with SBRT. We evaluated biochemical response according to PSA level every 3 months after SBRT: a 3-month PSA decrease from pre-SBRT PSA of more than 10% identified responder patients. In case of PSA level increase, imaging was performed to evaluate clinical progression. Toxicity was assessed every 6 to 9 months after SBRT.
  
  
  
  Median follow-up was 18.5 months. In 13 patients (14%) Grade 1 to 2 toxicity was reported without any Grade 3 to 4 toxicity. Biochemical response, stabilization, and progression were observed in 64 (68%), 10 (11%), and 20 (21%) of 94 evaluable patients. Clinical progression was observed in 31 patients (33%) after a median time of 8.1 months. In-field progression occurred in 12 lesions (9.7%). Two-year local control and PFS rates were 84% and 30%, respectively. Age older than 75 years correlated with better biochemical response rate. Age older than 75 years, concomitant AD administered up to 12 months, and pelvic LN involvement correlated with longer PFS.
  
  
  
  SBRT is safe and offers good in-field control. At 2 years after SBRT, 1 of 3 patients is progression-free. Further investigation is warranted to identify patients who benefit most from SBRT and to define the optimal combination with AD.
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
authors.forename: Barbara Alicja
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy. Electronic address: giuseppe.fanetti@ieo.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fanetti
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Fodor
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Delia
authors.initials: D
authors.lastname: Ciardo
authors.affiliation: Department of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoro
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
authors.forename: Claudia Maria
authors.initials: CM
authors.lastname: Francia
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Muto
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Surgo
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Zerini
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Marvaso
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Timon
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Romanelli
authors.affiliation: Unit of Medical Physics, European Institute of Oncology, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Rondi
authors.affiliation: Unit of Medical Physics, European Institute of Oncology, Milan, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Comi
authors.affiliation: Unit of Medical Physics, European Institute of Oncology, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cattani
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Golino
authors.affiliation: Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Mazza
authors.affiliation: Department of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Deliu Victor
authors.initials: DV
authors.lastname: Matei
authors.affiliation: Department of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferro
authors.affiliation: Department of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Musi
authors.affiliation: Division of Urogenital and Head and Neck Tumours, Department of Medical Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Nolè
authors.affiliation: Department of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: de Cobelli
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Piet
authors.initials: P
authors.lastname: Ost
authors.affiliation: Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Scientific Directorate, European Institute of Oncology, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000532:radiotherapy*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen
keywords: Lymph node recurrence; Oligometastases; Recurrent prostate cancer; Robotic stereotactic radiotherapy; Salvage radioablation