Vol 24, No 5 (2019)
Original research articles
Published online: 2019-09-01

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Multiparametric magnetic resonance imaging-guided salvage radiotherapy in prostate cancer

Felipe Couñago123, Ana Aurora Díaz Gavela123, Gemma Sancho4, Irene Ortiz5, Francisco José Marcos123, Manuel Recio6, Julio Fernández6, Raquel Cano6, Mar Jiménez6, Israel J. Thuissard7, David Sanz-Rosa8, Juan Castro Nováis9, Eduardo Pardo9, Yolanda Molina9, Hugo Pérez García9, Elia del Cerro128
DOI: 10.1016/j.rpor.2019.07.008
Rep Pract Oncol Radiother 2019;24(5):472-480.

Abstract

Aim

To analyse the efficacy and toxicity of postprostatectomy SRT in patients with a BCR evaluated with mpMRI.

Background

Multiparametric magnetic resonance imaging (mpMRI) has the ability to detect the site of pelvic recurrence in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). However, we do not know the oncological outcomes of mpMRI-guided savage radiotherapy (SRT).

Results

Local, lymph node, and pelvic bone recurrence was observed in 13, 4 and 2 patients, respectively. PSA levels were significantly lower in patients with negative mpMRI (0.4ng/mL [0.4]) vs. positive mpMRI (2.2ng/mL [4.1], p=0.003). Median planning target volume doses in patients with visible vs. non-visible recurrences were 76Gy vs. 70Gy. Overall, mean follow-up was 41 months (6–81). Biochemical relapse-free survival (bRFS) at 3 years was 82.3% and 82.5%, respectively, for the negative and positive mpMRI groups (p=0.800). Three-year rates of late grade ≥2 urinary and rectal toxicity were 14.8% and 1.9%, respectively; all but one patient recovered without sequelae.

Conclusion

SRT to the macroscopic recurrence identified by mpMRI is a feasible and well-tolerated option. In this study, there were no differences in bRFS between MRI-positive and MRI-negative patients, indicating effective targeting of MRI-positive lesions.

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