Massive Prostate Recurrence Previously RT Field

[Haybrant]

69 man treated with EBRT to 7920 in 2012 for high risk prostate cancer recurred in prostate bed in 2016 and found to have visceral and osseous mets. A rebiopsy showed small cell of the prostate. He has been on chemo for the last two years with a good response in his mets but has been progressing at primary site. He has significant rectal pain with CT showing his prostate measuring 10 x 8 cm w rectal invasion. Would you consider offering palliative RT now, Maybe being small cell he'll have some response but obviously he's already gotten 80 Gy here. Would you consider trying something like 200 x 15, 250 x 10, something else? Thanks all

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[Brim]

69 man treated with EBRT to 7920 in 2012 for high risk prostate cancer recurred in prostate bed in 2016 and found to have visceral and osseous mets. A rebiopsy showed small cell of the prostate. He has been on chemo for the last two years with a good response in his mets but has been progressing at primary site. He has significant rectal pain with CT showing his prostate measuring 10 x 8 cm w rectal invasion. Would you consider offering palliative RT now? Maybe being small cell he'll have some response but obviously he's already gotten 80 Gy here. Would you consider trying something like 250 x 10?

Damned if you do, damned if you don't.

I'd probably offer palliative RT to around 30/10 (or 250 x 10). Prognosis is very poor.

 

[evilbooyaa]

Agree with above. I would lean towards gentler fractionation as well in this clinical scenario given the small cell histology. 1.5 BID x 10 days? Probably too fancy, I think 250 x 15 or 300 x 10 would be my main go tos. Discussion about risk of worsening rectal toxicity with re-irradiation.

 

[ramsesthenice]

69 man treated with EBRT to 7920 in 2012 for high risk prostate cancer recurred in prostate bed in 2016 and found to have visceral and osseous mets. A rebiopsy showed small cell of the prostate. He has been on chemo for the last two years with a good response in his mets but has been progressing at primary site. He has significant rectal pain with CT showing his prostate measuring 10 x 8 cm w rectal invasion. Would you consider offering palliative RT now, Maybe being small cell he'll have some response but obviously he's already gotten 80 Gy here. Would you consider trying something like 200 x 15, 250 x 10, something else? Thanks all

I had a similar case recently though the interval from prior RT was a bit longer. Dude developed a squam of the bladder, got a cystectomy, and then developed a big recurrence in the operative bed with gross invasion of the rectum and was incredibly symptomatic (pain). His prostate radiation was about 8 years ago. I decided give him 1.25 BID to 40 (after polling basically everyone I know). He had an excellent response and is off pain meds now. I am 6 months out now and nothing terrible has happened yet.

 

[Palex80]

Before you treat have a rectoscopy done. If the rectum looks ugly I'd walk away from this one.