Piotr Wysocki: Salvage re-irradiation is a feasible option in locally recurrent prostate cancer after primary curative radiotherapy

Piotr Wysocki recently shared on LinkedIn:

“Locally recurrent prostate cancer (PC) in patients who underwent primary curative radiation therapy represents a significant clinical challenge. Unlike patients after radical prostatectomy in whom salvage radiotherapy represents a well-established clinical practice, little robust data supports the choice of the optimal approach to relapsed patients following curative irradiation. Usually, the patients are offered salvage surgical treatment since there is still a lot of concern around the safety of salvage re-irradiation.

Ekanger C et al. published the results of a prospective study after 7.2 years of follow-up, which included 38 patients (median age – 70 years) with biopsy-proven recurrent PC (median time from primary radiation to biochemical recurrence – 83 months). All enrolled patients had a history of well-tolerated primary curative radiotherapy (>2 years before enrollment) with no G2-3 adverse events. The salvage treatment comprised irradiation (35 Gy in five fractions) to the MRI-based target volume and 6 months of androgen-deprivation therapy (ADT) starting 3 months before radiation.

The results of salvage radiotherapy and adjuvant ADT at a 5-year time point were as follows:

• Biochemical relapse-free survival (bRFS) –58%
• Local recurrence-free survival (lRFS) – 93%
• Metastasis-free survival (MFS) – 82%
• Overall survival (OS) – 87%

The salvage reirradiation was well tolerated, with durable G3 genitourinary AE in two patients (5%), of whom one also experienced G3 gastrointestinal AE.

The greatest benefit from salvage re-irradiation was observed in patients:

• With relatively slow PSA doubling time (>6-12 months)
• With low tumor aggressiveness (GG 1-3/Gleason<8)
• Achieving PSA nadir (<0.1 ng/ml) after salvage radiotherapy

Although small, the study by Ekanger C et al. provides reassuring data indicating that salvage re-irradiation may be considered in patients with loco-regional relapse who have well-tolerated previous curative radiotherapy administered at least two years earlier.”

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Source: Piotr Wysocki/LinkedIn

Piotr Wysocki leads the Clinical Oncology Department at University Hospital and the Faculty of Oncology at Jagiellonian University-Medical College in Krakow, Poland. He has supervised four PhDs, trained numerous oncology residents, and contributed to national guidelines for genitourinary and breast cancer treatment. As an advisor to the Polish Ministry of Health, he shapes the national cancer strategy. Wysocki established early-phase clinical study units and specializes in systemic treatment for breast, gynecologic, and genitourinary cancers. His clinical expertise spans the systemic treatment of breast, gynecologic, and genitourinary cancers, with a focus on developing innovative metronomic chemotherapy-based therapies for advanced cancer patients who have undergone prior treatment. His scientific pursuits encompass the development and utilization of Immunopheresis in solid tumor treatment and the management of immune-related adverse events. He has led over 70 international clinical studies and published extensively in cancer research. Since 2023, he has been a member of the American Society of Clinical Oncology International Affairs Committee.