Reirradiation of Locally Recurrent Prostate Cancer with Cyberknife(®) System or Volumetric Modulated Arc Therapy (VMAT) and IGRT-Clarity(®): Outcomes, Toxicities and Dosimetric Evaluation

SIMPLE SUMMARY: From April 2017 to December 2020, 29 patients with prostate cancer recurrence were selected. They received Cyberknife(®) (CK) treatment (17 pts) or alternatively VMAT (Volumetric Modulated Arc Technique) therapy by IGRT (Image-Guided Radiation Therapy)/Clarity(®) (12 pts). Urinary (GU), rectal (GI) toxicities, and biochemical control were investigated. Further, the two techniques were dosimetrically compared by rival plans. The VMAT-IGRT Clarity(®) treatments were replanned applying a template developed for prostate VMAT-SBRT in FFF mode, keeping the same dose/fractionation scheduled for the CK Group (30 Gy in 5 fx at 80% isodose). In the CK group, 23% of patients experienced grade 2 acute GU, while 6% showed grade 2 acute GI. In the VMAT-Clarity(®) group, 17% of patients showed acute GU toxicity, while for 8% grade 2 late toxicity was recorded. The dosimetric analysis shows that VMAT-FFF allows to deliver a biological equivalent dose to CK, with the advantage of reducing the likelihood of toxicities arising. ABSTRACT: The management of prostate cancer recurrence following external beam radiotherapy is not defined yet. Stereotaxic body reirradiation therapy showed encouraging results for local and biochemical control. From April 2017 to December 2020, 29 patients with prostate cancer recurrence were collected, joining the retrospective studies CyPro (prot. 46/19 OSS) and CLARO (Prot. 19/20 OSS) trials. Patients received Cyberknife(®) treatment (17 pts) or alternatively VMAT (Volumetric Modulated Arc Technique) therapy by IGRT (Image-Guided Radiation Therapy)/Clarity(®) (12 pts). By comparing the reirradiation of two groups, urinary (GU), rectal (GI) toxicities, and biochemical control were investigated. Further, the two techniques were dosimetrically compared by rival plans. The VMAT-IGRT Clarity(®) treatments were replanned with an optimized template developed for prostate VMAT-SBRT in FFF mode keeping the same dose and fractionation scheduled for Cyberknife Group (30 Gy in 5 fx, at 80% isodose). In the CK group, 23% of patients experienced grade 2 acute GU, while 6% grade 2 acute GI. In the VMAT-Clarity(®) group, acute GU toxicity was recorded in 17%, while for 8% grade 2 late toxicity was recorded. The dosimetric analysis shows that the VMAT-FFF allows to deliver a biological equivalent dose to CK, with the advantage of reducing the likelihood of toxicities arising.