Jérémy Baude, Charles Teyssier, Vincent Barbier, Jack-Charles Tremeaux, Caroline Azélie, Alexis Lépinoy, Pierre-Charles Henry, Vincent Bailly, Nicolas Lescut, Edouard Lagneau, Benjamin Schipman
{"title":"用体积调制弧治疗（VMAT）对高强度聚焦超声（HIFU）后复发的前列腺癌进行挽救性放疗：法国大型回顾性系列研究与文献综述。","authors":"Jérémy Baude, Charles Teyssier, Vincent Barbier, Jack-Charles Tremeaux, Caroline Azélie, Alexis Lépinoy, Pierre-Charles Henry, Vincent Bailly, Nicolas Lescut, Edouard Lagneau, Benjamin Schipman","doi":"10.1016/j.radonc.2024.110665","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and purpose: </strong>Although not validated as a standard treatment, high-intensity focused ultrasound (HIFU) is increasingly used in the management of localised prostate cancer (PCa). In case of recurrence after HIFU, treatment is currently not standardised. Our aim was to evaluate normofractionated (NFRT) and hypofractionated (HFRT) salvage radiotherapy (RT) using volumetric modulated arc therapy (s-VMAT) with doses used in first-line management of localised PCa.</p><p><strong>Material and methods: </strong>We identified all patients with local or locoregional recurrence after HIFU treated with s-VMAT in 3 RT centres between 2014 and 2023. We evaluated acute and late toxicity and oncological outcomes.</p><p><strong>Results: </strong>Fifty-six patients were identified. Median age at recurrence was 75 (70-80) years. Median time between HIFU and s-VMAT was 26.5 months (13.9-47.2). S-VMAT was delivered to the prostate only in 35 (62.5 %) patients and to the prostate and pelvis in 21 (37.5 %) patients. NFRT and HFRT were delivered in 46 (82.1 %) and 10 (17.9 %) patients, respectively. Androgen deprivation therapy (ADT) was given to 27 (48.2 %) patients. Eighteen (32 %) and four (7 %) patients reported an acute grade 2 genitourinary (GU) and gastrointestinal (GI) adverse event (AE), respectively. Two patients presented with a late grade 2 GU AE, and one with a late grade 2 GI AE. No grade 3+ toxicity was reported. With a median follow-up of 19.5 months (12 - 47), no patient had a biochemical, local or distant relapse.</p><p><strong>Conclusions: </strong>This is the largest series of salvage RT after HIFU using VMAT and escalated doses (78-80 Gy/39-40Fr., or 60 Gy/20Fr.). Acute toxicity was acceptable and late AEs were few. Longer follow-up is required to assess efficacy. Overall, available series suggest that salvage RT could represent a valuable option in the treatment of relapses after HIFU.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110665"},"PeriodicalIF":4.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Salvage radiotherapy with volumetric modulated arc therapy (VMAT) for recurrent prostate cancer after high-intensity focused ultrasound (HIFU): A large French retrospective series and literature review.\",\"authors\":\"Jérémy Baude, Charles Teyssier, Vincent Barbier, Jack-Charles Tremeaux, Caroline Azélie, Alexis Lépinoy, Pierre-Charles Henry, Vincent Bailly, Nicolas Lescut, Edouard Lagneau, Benjamin Schipman\",\"doi\":\"10.1016/j.radonc.2024.110665\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and purpose: </strong>Although not validated as a standard treatment, high-intensity focused ultrasound (HIFU) is increasingly used in the management of localised prostate cancer (PCa). In case of recurrence after HIFU, treatment is currently not standardised. Our aim was to evaluate normofractionated (NFRT) and hypofractionated (HFRT) salvage radiotherapy (RT) using volumetric modulated arc therapy (s-VMAT) with doses used in first-line management of localised PCa.</p><p><strong>Material and methods: </strong>We identified all patients with local or locoregional recurrence after HIFU treated with s-VMAT in 3 RT centres between 2014 and 2023. We evaluated acute and late toxicity and oncological outcomes.</p><p><strong>Results: </strong>Fifty-six patients were identified. Median age at recurrence was 75 (70-80) years. Median time between HIFU and s-VMAT was 26.5 months (13.9-47.2). S-VMAT was delivered to the prostate only in 35 (62.5 %) patients and to the prostate and pelvis in 21 (37.5 %) patients. NFRT and HFRT were delivered in 46 (82.1 %) and 10 (17.9 %) patients, respectively. Androgen deprivation therapy (ADT) was given to 27 (48.2 %) patients. Eighteen (32 %) and four (7 %) patients reported an acute grade 2 genitourinary (GU) and gastrointestinal (GI) adverse event (AE), respectively. Two patients presented with a late grade 2 GU AE, and one with a late grade 2 GI AE. No grade 3+ toxicity was reported. With a median follow-up of 19.5 months (12 - 47), no patient had a biochemical, local or distant relapse.</p><p><strong>Conclusions: </strong>This is the largest series of salvage RT after HIFU using VMAT and escalated doses (78-80 Gy/39-40Fr., or 60 Gy/20Fr.). Acute toxicity was acceptable and late AEs were few. Longer follow-up is required to assess efficacy. Overall, available series suggest that salvage RT could represent a valuable option in the treatment of relapses after HIFU.</p>\",\"PeriodicalId\":21041,\"journal\":{\"name\":\"Radiotherapy and Oncology\",\"volume\":\" \",\"pages\":\"110665\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Radiotherapy and Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.radonc.2024.110665\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/15 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.radonc.2024.110665","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/15 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Salvage radiotherapy with volumetric modulated arc therapy (VMAT) for recurrent prostate cancer after high-intensity focused ultrasound (HIFU): A large French retrospective series and literature review.
Background and purpose: Although not validated as a standard treatment, high-intensity focused ultrasound (HIFU) is increasingly used in the management of localised prostate cancer (PCa). In case of recurrence after HIFU, treatment is currently not standardised. Our aim was to evaluate normofractionated (NFRT) and hypofractionated (HFRT) salvage radiotherapy (RT) using volumetric modulated arc therapy (s-VMAT) with doses used in first-line management of localised PCa.
Material and methods: We identified all patients with local or locoregional recurrence after HIFU treated with s-VMAT in 3 RT centres between 2014 and 2023. We evaluated acute and late toxicity and oncological outcomes.
Results: Fifty-six patients were identified. Median age at recurrence was 75 (70-80) years. Median time between HIFU and s-VMAT was 26.5 months (13.9-47.2). S-VMAT was delivered to the prostate only in 35 (62.5 %) patients and to the prostate and pelvis in 21 (37.5 %) patients. NFRT and HFRT were delivered in 46 (82.1 %) and 10 (17.9 %) patients, respectively. Androgen deprivation therapy (ADT) was given to 27 (48.2 %) patients. Eighteen (32 %) and four (7 %) patients reported an acute grade 2 genitourinary (GU) and gastrointestinal (GI) adverse event (AE), respectively. Two patients presented with a late grade 2 GU AE, and one with a late grade 2 GI AE. No grade 3+ toxicity was reported. With a median follow-up of 19.5 months (12 - 47), no patient had a biochemical, local or distant relapse.
Conclusions: This is the largest series of salvage RT after HIFU using VMAT and escalated doses (78-80 Gy/39-40Fr., or 60 Gy/20Fr.). Acute toxicity was acceptable and late AEs were few. Longer follow-up is required to assess efficacy. Overall, available series suggest that salvage RT could represent a valuable option in the treatment of relapses after HIFU.
期刊介绍：
Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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