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Evaluation of the safety and efficacy of stereotactic body radiotherapy for radio-recurrent prostate cancer: a systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases volume 28, pages 718–726 (2025)Cite this article

Subjects

Abstract

Background

Stereotactic body radiotherapy (SBRT) is pivotal in managing radio-recurrent prostate cancer (PCa). This study aims to comprehensively review its efficacy and associated severe toxicities.

Methods

A thorough review of PubMed and EMBASE databases up to July 2024 was conducted to assess recurrence-free survival (RFS) with salvage SBRT across various subgroups. Survival curves were reconstructed using WebPlotDigitizer and a newly developed shiny application.

Results

Thirty-six studies were analyzed, with 15 papers (682 patients) contributing to survival curve reconstruction. Median RFS was 36.2 months, with 2-, 3-, and 5-year rates of 64.8%, 50.7%, and 40.6%, respectively. Factors associated with improved RFS included whole-gland irradiation [focal vs. whole, hazard ratio (HR) 1.83 (95% CI: 1.16–2.87), p = 0.008], and higher biologically effective dose (BED) [120–138.1 Gy vs. 144–167.7 Gy, HR 1.40 (95% CI: 1.07–1.83), p = 0.015]. Severe (grade ≥ 3) acute and late genitourinary (GU) toxicities occurred in 1.4% (95% CI: 0.8–2.3) and 3.7% (95% CI: 2.6–4.9) of patients, respectively. Severe acute and late gastrointestinal (GI) toxicities were reported in 0.5% (95% CI: 0.2–1.1) and 0.4% (95% CI: 0.1–1.0) of patients, respectively. Combined severe GU and GI toxicities were observed in 5.8% (95% CI: 4.5–7.4) and 1.3% (95% CI: 0.7–2.2) of patients, respectively.

Conclusions

This study provides a comprehensive assessment of toxicities and conducts a pooled analysis of RFS for salvage SBRT in radio-recurrent PCa. Factors such as whole-gland irradiation, and higher BED show promise as prognostic indicators for RFS. However, confirmation through randomized controlled trials is essential due to the low levels of evidence and study heterogeneity.

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Fig. 1
Fig. 2: The RFS curves of the radio-recurrent patients treated with salvage SBRT in different subgroups.
Fig. 3

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Acknowledgements

This work was supported by grants from Shaoxing People’s Hospital Youth Fund (2023YB30) and Health Science and Technology Plan Project of Zhejiang (2024KY1714；2023KY366).

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  1. These authors contributed equally: Yali Meng, Jianjiang Liu.

Authors and Affiliations

  1. Department of Radiotherapy, Shaoxing People’s Hospital, Shaoxing, 312000, Zhejiang, China

    Yali Meng, Jianjiang Liu & Dongping Wu

  2. Department of Urology, Shaoxing People’s Hospital, Shaoxing, 312000, Zhejiang, China

    Bin Shen & Huali Xu

  3. School of Medicine, Shaoxing University, No.568 Zhongxing North Road, Yuecheng District, 312000, Shaoxing, Zhejiang, China

    Yufei Ying

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Contributions

YY, JL, YM, HX, and BS designed the study, analyzed data, and ensured data quality. BS and HX provided funding and support. YM, YY and JL led the study, verified the data, and wrote the manuscript. YY, JL, YM, HX, DW and BS contributed to data interpretation, reviewed, revised, approved the manuscript, had full access to the data, and accepted responsibility for submission.

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Correspondence to Yufei Ying.

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Meng, Y., Liu, J., Shen, B. et al. Evaluation of the safety and efficacy of stereotactic body radiotherapy for radio-recurrent prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 28, 718–726 (2025). https://doi.org/10.1038/s41391-024-00927-8

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