Objectives.

Patients with metastasized prostate cancer after primary treatment are

generally considered palliative and Androgen Deprivation is considered the current
standard therapy. Oligometastatic patients often have a long survival time, and non
invasive low-toxicity approaches could be of great value to this large patients population.
We investigated the role of Salvage Stereotactic Radiotherapy for patients with limited
prostate cancer metastases to defer the initiation of palliative Androgen Deprivation
Therapy (ADT).
Methods and Materials. Between March 2009 and march 2013 a cohort of 30 patients
with up to 3 synchronous lymph node prostate metastases staged with (11C)- choline
positron emission tomography (47 lesions with a median volume of 12,92 cc, range 0,39
-111,67) , following biochemical recurrence after local curative treatment were treated
with Cyberknife Stereotactic Body Radiotherapy in our Center. The mean age of patients
population at the time of the Cyberknife treatment was 68 years (range 55-84). Cyberknife
prescription doses were 3000 -3600 cGy delivered in 3 consecutive fractions of 1000-1200
cGy. The dose was prescribed to the mean 80% isodose line by use on a non isocentric
Cyberknife treatment technique. In 14 lesions (37%) Cyberknife Stereotactic Radiotherapy
Treatment (SBRT) was performed as reirradiation (the recurrent lesion was situated in the
previously irradiated volume). Clinical progression was defined as the detection of local
progression or distant disease at reassessment. In case of an oligometastatic recurrence
outside the previous Stereotactic Body Irradiated field, a re-treatment was performed.
Androgen Deprivation (ADT) was initiated if more than 3 metastases were detected during
follow up even when patients were still asymptomatic. Toxicity was scored using the
Common Terminology Criteria for Adverse Events.
Results. The Cyberknife treatment was well tolerated without any acute or late toxicity at
all. There were no in field recurrence ,resulting in a local control of 100%. Eleven and 3
patients, respectively required a second and third salvage treatment for metacronous
metastatic disease. The median time to clinical progression was 14 months (range 3-54).
After a median follow up of 33 months (range 13-73) 16 patients started with ADT because
of polymetastatic disease resulting in an ADT-FS of 80% at 1 year and 65% at 2 years.
The median time Androgen deprivation therapy (ADT) was deferred resulted of 26 months
(range 4-56).
Conclusions. The recent evidence of the potential toxic nature of Androgen Deprivation
Therapy (ADT) suggest that effective local therapy might reduce the burden of systemic
therapies usually given to patients with metastatic prostate cancer. Cyberknife salvage
Hypofractionation Stereotactic Body radiotherapy is a safe and effective treatment option
in patients with lymph node prostate metastases and could defer initiation of palliative
Androgen Deprivation Therapy.
Outline:
Robotic Image-guided stereotactic radiotherapy
Androgen Deprivation Therapy (ADT)
Lymph node prostate metastases