Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation
Purpose: Whole gland cryoablation is a guideline-approved definitive treatment for localized prostate cancer, and is being explored for partial gland ablation. However, there is limited data regarding management of cryoablation failures. Stereotactic body radiation therapy (SBRT) is a well-establish...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-05-01
|
| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109421002074 |
| _version_ | 1818244930045214720 |
|---|---|
| author | Jonathan W. Lischalk, MD Aaron E. Katz, MD Seth R. Blacksburg, MD, MBA Christopher Mendez, MA Astrid Sanchez, MS Michael C. Repka, MD Matthew Witten, PhD Samir Taneja, MD Herbert Lepor, MD Jonathan A. Haas, MD |
| author_facet | Jonathan W. Lischalk, MD Aaron E. Katz, MD Seth R. Blacksburg, MD, MBA Christopher Mendez, MA Astrid Sanchez, MS Michael C. Repka, MD Matthew Witten, PhD Samir Taneja, MD Herbert Lepor, MD Jonathan A. Haas, MD |
| author_sort | Jonathan W. Lischalk, MD |
| collection | DOAJ |
| description | Purpose: Whole gland cryoablation is a guideline-approved definitive treatment for localized prostate cancer, and is being explored for partial gland ablation. However, there is limited data regarding management of cryoablation failures. Stereotactic body radiation therapy (SBRT) is a well-established method of primary treatment for prostate cancer. Here we review salvage SBRT after cryoablation failures. Methods and Materials: A large database of patients treated with definitive SBRT was interrogated to identify those who underwent primary cryoablation. All patients were determined to have progressive disease based on a rising prostate specific antigen and/or postcryoablation biopsy. All patients were treated with SBRT over 5 treatment fractions using a robotic radiosurgical platform. Baseline cryoablation characteristics and pre- and posttreatment Expanded Prostate Cancer Index Composite questionnaires were analyzed. Acute and late toxicity was evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. Cancer outcomes after salvage SBRT were stratified by disease and treatment characteristics. Results: A total of 51 patients were identified who underwent cryoablation followed by salvage SBRT. The majority (47%) were found to have intermediate-risk disease at the time of SBRT salvage and most commonly were treated with 3500 cGy in 5 fractions to the prostate and seminal vesicles. Only 1 grade 3+ toxicity was identified. Patient-reported quality of life metrics after SBRT salvage followed prior patterns observed in the de novo SBRT setting. With a median follow-up of 40 months, 76% of the cohort demonstrated disease control. Median time to prostate cancer recurrence was 57.5 months, and recurrence was predominantly seen in patients with underlying high-risk disease. Conclusions: This is the largest cohort of patients treated with any radiation therapy salvage after cryoablation and the first institution to report SBRT as a modality of salvage. Salvage SBRT after cryoablation results in low rates of high-grade toxicity, acceptable changes in patient-reported quality of life, and durable rates of long-term oncologic control. |
| first_indexed | 2024-12-12T14:24:50Z |
| format | Article |
| id | doaj.art-0a5474b586bc44d69f199e22a36cb672 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-12T14:24:50Z |
| publishDate | 2022-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-0a5474b586bc44d69f199e22a36cb6722022-12-22T00:21:43ZengElsevierAdvances in Radiation Oncology2452-10942022-05-0173100849Salvage Prostate Stereotactic Body Radiation Therapy After Definitive CryoablationJonathan W. Lischalk, MD0Aaron E. Katz, MD1Seth R. Blacksburg, MD, MBA2Christopher Mendez, MA3Astrid Sanchez, MS4Michael C. Repka, MD5Matthew Witten, PhD6Samir Taneja, MD7Herbert Lepor, MD8Jonathan A. Haas, MD9Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital−Long Island, Mineola, New York; Corresponding author: Jonathan W. Lischalk, MDDepartment of Urology at New York University Long Island School of Medicine, Mineola, New YorkDepartment of Radiation Medicine, Lenox Hill Hospital–Northwell Health, New York, New YorkDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital−Long Island, Mineola, New YorkDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital−Long Island, Mineola, New YorkDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital−Long Island, Mineola, New YorkDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital−Long Island, Mineola, New YorkDepartment of Urology, New York University School of Medicine, New York, New YorkDepartment of Urology, New York University School of Medicine, New York, New YorkDepartment of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital−Long Island, Mineola, New YorkPurpose: Whole gland cryoablation is a guideline-approved definitive treatment for localized prostate cancer, and is being explored for partial gland ablation. However, there is limited data regarding management of cryoablation failures. Stereotactic body radiation therapy (SBRT) is a well-established method of primary treatment for prostate cancer. Here we review salvage SBRT after cryoablation failures. Methods and Materials: A large database of patients treated with definitive SBRT was interrogated to identify those who underwent primary cryoablation. All patients were determined to have progressive disease based on a rising prostate specific antigen and/or postcryoablation biopsy. All patients were treated with SBRT over 5 treatment fractions using a robotic radiosurgical platform. Baseline cryoablation characteristics and pre- and posttreatment Expanded Prostate Cancer Index Composite questionnaires were analyzed. Acute and late toxicity was evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. Cancer outcomes after salvage SBRT were stratified by disease and treatment characteristics. Results: A total of 51 patients were identified who underwent cryoablation followed by salvage SBRT. The majority (47%) were found to have intermediate-risk disease at the time of SBRT salvage and most commonly were treated with 3500 cGy in 5 fractions to the prostate and seminal vesicles. Only 1 grade 3+ toxicity was identified. Patient-reported quality of life metrics after SBRT salvage followed prior patterns observed in the de novo SBRT setting. With a median follow-up of 40 months, 76% of the cohort demonstrated disease control. Median time to prostate cancer recurrence was 57.5 months, and recurrence was predominantly seen in patients with underlying high-risk disease. Conclusions: This is the largest cohort of patients treated with any radiation therapy salvage after cryoablation and the first institution to report SBRT as a modality of salvage. Salvage SBRT after cryoablation results in low rates of high-grade toxicity, acceptable changes in patient-reported quality of life, and durable rates of long-term oncologic control.http://www.sciencedirect.com/science/article/pii/S2452109421002074 |
| spellingShingle | Jonathan W. Lischalk, MD Aaron E. Katz, MD Seth R. Blacksburg, MD, MBA Christopher Mendez, MA Astrid Sanchez, MS Michael C. Repka, MD Matthew Witten, PhD Samir Taneja, MD Herbert Lepor, MD Jonathan A. Haas, MD Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation Advances in Radiation Oncology |
| title | Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation |
| title_full | Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation |
| title_fullStr | Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation |
| title_full_unstemmed | Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation |
| title_short | Salvage Prostate Stereotactic Body Radiation Therapy After Definitive Cryoablation |
| title_sort | salvage prostate stereotactic body radiation therapy after definitive cryoablation |
| url | http://www.sciencedirect.com/science/article/pii/S2452109421002074 |
| work_keys_str_mv | AT jonathanwlischalkmd salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation AT aaronekatzmd salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation AT sethrblacksburgmdmba salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation AT christophermendezma salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation AT astridsanchezms salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation AT michaelcrepkamd salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation AT matthewwittenphd salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation AT samirtanejamd salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation AT herbertlepormd salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation AT jonathanahaasmd salvageprostatestereotacticbodyradiationtherapyafterdefinitivecryoablation |