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To investigate both the pattern of failure and the opportunity of a repeated radiotherapy course after salvage radiation therapy (sRT) for prostate cancer (PC). At our Institution, all patients (pts) who develop a further biochemical failure (BF) after both radical prostatectomy and subsequent sRT are offered re-staging with prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) first, and, if negative, with multiparametric magnetic resonance imaging (mpMRI) of the prostatic fossa. In the present study we included the pts who satisfied all the following criteria since March 2023: no pathologically positive nodes at surgery; no distant disease at re-staging PET/CT before sRT; subsequent BF after sRT defined as Prostate-specific antigen (PSA) > 0.20 ng/ml on 2 consecutive measures; presence of recurrent disease at either PSMA PET/CT and/or mpMRI. Pts without detectable disease at imaging were disregarded. The site(s) of failure (FS) was (were) classified as Local (LS) if within the prostatic fossa, Regional (RS) if within the pelvic nodes up to the common iliacs excluded, and Distant (DS) if outside the pelvis. Oligorecurrence was defined as a maximum of 5 FS on imaging. After co-registering the positive re-staging imaging and the planning CT at sRT, we assessed whether each FS was outside (OFS) or inside (IFS) the previously treated volume and we estimated the mean equivalent dose in 2 Gy fraction (EDmean2) received by each IFS. Fifty-six consecutive pts were included. 29 (52%) pts had received prostatic fossa sRT only and 27 (48%) pts also whole pelvis sRT. Only 5 pts (9%) had undergone concurrent androgen deprivation therapy at sRT. Median PSA nadir after sRT was 0.06 ng/ml (IQR 0.01-0.3 ng/ml) and occurred after 7.8 months (IQR: 4-16.5 months). All pts were restaged with PSMA PET/CT and 21 pts (38%) with mpMRI. We found an overall number of 83 recurrences at a median time of 41 months after sRT (IQR 19.9-65.2 months). At failure, the median PSA was 0.63 ng/ml (IQR 0.4-1.2 ng/ml) and the median PSA doubling time was 8.3 months (IQR 4.3-12.3 months). All patients were oligorecurrent. Failures were distributed as follows: 39 (47%) DS, 26 (31%) RS and 18 (22%) LS. 60 (72%) were OFS, whereas 23 (28%) were IFS; of the latter ones, 14 were LS, 7 RS and 2 DS, with a median EDmean2 of 75.2 Gy (IQR 73-78.7 Gy), 50 Gy (IQR 45.4-51.6 Gy) and 53.1 Gy (IQR 57.6-48.6 Gy), respectively. All LS had undergone a staging mpMRI at sRT and 13 (72%) occurred in a previously positive prostatic fossa. All patients are oligorecurrent at the time of a BF post-sRT. Moreover, most of the failures do occur outside a previously treated volume. For both reasons, a second course of definitive/ablative RT is potentially indicated. Surprisingly, the prostatic fossa is a relatively frequent site of failure especially when containing macroscopic disease and despite the high dosage at sRT. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): To report the results of a phases 1 and 2 study on stereotactic body radiation therapy (SBRT) for early glottic cancer., Methods and Materials: This a prospective study at a single institution enrolling patients with T1 glottic cancer. The true vocal cords (TVCs) were divided into thirds and the third(s) containing disease prescribed 36 Gy in 3 fractions. The portions of the TVCs next to the involved one were planned to receive 30 Gy in 3 fxs. SBRT was delivered by a linear accelerator-based approach using multiple arcs. Toxicity was scored by Common Terminology Criteria for Adverse Events and late events were considered those occurring 3 months after SBRT. Voice quality was investigated by the Voice Handicap Index at regular intervals. The planned sample size was 75 patients., Results: Accrual was discontinued after 33 patients because of concerns for late toxicity. T stage was as follows: T1a: 23 patients (69.7%); T1b: 10 patients (30.3%). All patients received the planned treatment and the median follow-up time was 51.5 months (IQR, 47.9-61.0 months). At last follow-up, all patients were alive and without evidence of disease but 2 patients who died for intercurrent causes. The local control rate was 100% at 4 years. Six patients (18.2%) developed soft tissue necrosis (N = 4) or cartilage necrosis (N = 2) after a median time of 14.9 months from SBRT. Five out of 6 necrotic events were observed in patients who kept smoking and/or had a recent COVID infection. All 4 soft tissue events healed with conservative therapy. After an initial deterioration, the average Voice Handicap Index score significantly improved at 6 months over baseline., Conclusions: SBRT to 36 Gy in 3 fractions is highly effective in controlling T1 TVC carcinoma, but necrosis, although mostly transient, is a concern. On the basis of the present results, a reduction in total dose and a more accurate patient selection are warranted., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Erectile dysfunction (ED) is a common side effect after prostate cancer stereotactic body radiation therapy (SBRT). We aimed to assess the correlation between the dose to the penile bulb (PB), internal pudendal arteries (IPA), and crura with the development of ED after ultrahypofractionation as part of a phase 2 clinical trial of urethra-sparing prostate SBRT., Methods and Materials: Among the 170 patients with localized prostate cancer from 9 centers included in the trial, 90 men with Common Terminology Criteria for Adverse Events version 4.03 grade 0 to 1 ED (ED-) at baseline treated with 36.25 Gy in 5 fractions were selected for the present analysis. Doses delivered to the PB, crura, and IPA were analyzed and correlated with grade 2 to 3 ED (ED+) development. The effect on quality of life, assessed by the European Organisation for Research and Treatment of Cancer (EORTC QLQ-PR25) questionnaire, was reported., Results: After a median follow-up of 6.5 years, 43% (n = 39) of the patients developed ED+, and 57% (n = 51) remained ED-. The dose delivered to the crura was significantly higher in ED+ patients than in ED- patients (7.7 vs 3.6 Gy [P = .014] for the D mean and 18.5 vs 7.2 Gy [P = .015] for the D 2% , respectively). No statistically significant difference between ED+ and ED- patients was observed for the dose delivered to the PB and IPA. The median ED+-free survival was worse in patients receiving a crura D mean ≥ 4.7 versus < 4.7 Gy (51.5% vs 71.7%, P = .005) and a crura D 2% > 12 versus ≤ 12 Gy (54.9% vs 68.9%, P = .015). No ED+-free survival differences were observed for doses delivered to the PB and IPA. Decline in EORTC QLQ-PR25 sexual functioning was significantly more pronounced in patients with higher doses to the crura., Conclusions: By keeping a D mean and D 2% to crura below 4.7 and 12 Gy, respectively, the risk of developing ED+ after prostate SBRT may be significantly reduced., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)