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Giraud N, Benziane-Ouaritini N, Schick U, Beauval JB, Chaddad A, Niazi T, Faye MD, Supiot S, Sargos P, Latorzeff I. Post-Operative Radiotherapy in Prostate Cancer: Is It Time for a Belt and Braces Approach? Front Oncol 2021; 11:781040. [PMID: 34881187 PMCID: PMC8647553 DOI: 10.3389/fonc.2021.781040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
Approximately 30% of patients treated with radical prostatectomy (RP) for prostate cancers experience biochemical recurrence (BCR). Post-operative radiation therapy (RT) can be either offered immediately after the surgery in case of aggressive pathological features or proposed early if BCR occurs. Until recently, little data were available regarding the optimal RT timing, protocol, volumes to treat, and the benefit of adding androgen deprivation therapies to post-operative RT. In this review, we aim to pragmatically discuss current literature data on these points. Early salvage RT appears to be the optimal post-operative approach, improving oncological outcomes especially with low prostate-specific antigen (PSA) levels, as well as sparing several unnecessary adjuvant treatments. The standard RT dose is still 64–66 Gy to the prostate bed in conventional fractionation, but hypofractionation protocols are emerging pending on late toxicity data. Several scientific societies have published contouring atlases, even though they are heterogeneous and deserve future consensus. During salvage RT, the inclusion of pelvic lymph nodes is also controversial, but preliminary data show a possible benefit for PSA > 0.34 ng/ml at the cost of increased hematological side effects. Concomitant ADT and its duration are also discussed, possibly advantageous (at least in terms of metastasis-free survival) for PSA rates over 0.6 ng/ml, taking into account life expectancy and cardiovascular comorbidities. Intensified regimens, for instance, with new-generation hormone therapies, could further improve outcomes in carefully selected patients. Finally, recent advances in molecular imaging, as well as upcoming breakthroughs in genomics and artificial intelligence tools, could soon reshuffle the cards of the current therapeutic strategy.
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Affiliation(s)
- Nicolas Giraud
- Radiation Oncology Department, Institut Bergonié, Bordeaux, France
| | | | - Ulrike Schick
- Radiation Oncology Department, University Hospital, Brest, France
| | | | - Ahmad Chaddad
- School of Artificial Intelligence, Guilin University of Electronic Technology, Guilin, China
| | - Tamim Niazi
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Mame Daro Faye
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Stéphane Supiot
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest, Nantes Saint-Herblain, France
| | - Paul Sargos
- Radiation Oncology Department, Institut Bergonié, Bordeaux, France
| | - Igor Latorzeff
- Radiation Oncology Department, Clinique Pasteur, Toulouse, France
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Schick U, Latorzeff I, Sargos P. Postoperative radiotherapy in prostate cancer: Dose and volumes. Cancer Radiother 2021; 25:674-678. [PMID: 34400088 DOI: 10.1016/j.canrad.2021.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/05/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Approximately thirty percent of patients experience biochemical recurrence after radical prostatectomy for prostate cancer. Early salvage radiotherapy has recently become a standard of care in this setting. The purpose of this review is first to summarize current knowledge in terms of dose to the prostate bed in light of the recent SAKK 09/10 randomized phase III trial results. The evidence on moderate hypofractionation will also be discussed whereas extreme hypofractionation remains highly investigational. Regarding target volumes, several different guidelines have been published to address the need for standardization of postoperative target delineation. The recent GFRU (Groupe Francophone de Radiothérapie Urologique) recommendations could represent an international consensus.
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Affiliation(s)
- U Schick
- Radiation Oncology Department, University Hospital, Brest, France; LaTIM, UMR 1101, INSERM, University Brest, Brest, France.
| | - I Latorzeff
- Department of Oncology Radiotherapy, Bât Atrium, Clinique Pasteur, Toulouse, France
| | - P Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
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