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Review

Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives

Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Author to whom correspondence should be addressed.
Cancers 2018, 10(12), 480; https://doi.org/10.3390/cancers10120480
Received: 19 October 2018 / Revised: 25 November 2018 / Accepted: 28 November 2018 / Published: 3 December 2018
(This article belongs to the Special Issue New Developments in Radiotherapy)
Over the last decades, primary prostate cancer radiotherapy saw improving developments, such as more conformal dose administration and hypofractionated treatment regimens. Still, prostate cancer recurrences after whole-gland radiotherapy remain common, especially in patients with intermediate- to high-risk disease. The vast majority of these patients are treated palliatively with androgen deprivation therapy (ADT), which exposes them to harmful side-effects and is only effective for a limited amount of time. For patients with a localized recurrent tumor and no signs of metastatic disease, local treatment with curative intent seems more rational. However, whole-gland salvage treatments such as salvage radiotherapy or salvage prostatectomy are associated with significant toxicity and are, therefore, uncommonly performed. Treatments that are solely aimed at the recurrent tumor itself, thereby better sparing the surrounding organs at risk, potentially provide a safer salvage treatment option in terms of toxicity. To achieve such tumor-targeted treatment, imaging developments have made it possible to better exclude metastatic disease and accurately discriminate the tumor. Currently, focal salvage treatment is being performed with different modalities, including brachytherapy, cryotherapy, high-intensity focused ultrasound (HIFU), and stereotactic body radiation therapy (SBRT). Oncologic outcomes seem comparable to whole-gland salvage series, but with much lower toxicity rates. In terms of oncologic control, these results will improve further with better understanding of patient selection. Other developments, such as high-field diagnostic MRI and live adaptive MRI-guided radiotherapy, will further improve precision of the treatment. View Full-Text
Keywords: prostate cancer; localized recurrence; focal therapy; salvage prostate cancer; localized recurrence; focal therapy; salvage
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MDPI and ACS Style

Van Son, M.; Peters, M.; Moerland, M.; Kerkmeijer, L.; Lagendijk, J.; Van der Voort van Zyp, J. Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives. Cancers 2018, 10, 480. https://doi.org/10.3390/cancers10120480

AMA Style

Van Son M, Peters M, Moerland M, Kerkmeijer L, Lagendijk J, Van der Voort van Zyp J. Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives. Cancers. 2018; 10(12):480. https://doi.org/10.3390/cancers10120480

Chicago/Turabian Style

Van Son, Marieke, Max Peters, Marinus Moerland, Linda Kerkmeijer, Jan Lagendijk, and Jochem Van der Voort van Zyp. 2018. "Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives" Cancers 10, no. 12: 480. https://doi.org/10.3390/cancers10120480

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