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Salvage radiotherapy (SRT) is one of the most widely used approaches in case of biochemical recurrence after radical prostatectomy for prostate cancer. Macroscopic recurrence within the prostate bed in this scenario is often detected through PSMA PET/CT or Magnetic resonance imaging (MRI). Stereotactic salvage radiotherapy (SSRT) has been proposed as a method to improve disease control by dose escalation in these patients. STARR is a prospective trial exploring clinical outcomes after SSRT on macroscopic recurrence within prostate bed after radical prostatectomy. STARR trial is a prospective multicenter study enrolling subjects affected by prostate bed macroscopic recurrence. All relapses were detected by Choline, PSMA CT-PET or MRI performed after a post prostatectomy PSA rise above 0.2 ng/ml. All patients with regional or distant metastatic disease were excluded. SSRT consisting in a total dose of 35 Gy in 5 fractions every other day was administered on macroscopic relapse defined through CT-PET and/or MRI co-registration with planning CT. Androgen Deprivation therapy (ADT) was not prescribed. A PSA nadir <0.2 ng/ml and <50% of baseline, respectively, were defined as complete biochemical response (CBR) or biochemical response (BR). Sixty-one patients were enrolled between March 2021 and November 2023. The current analysis included 50 enrolled patients at the promoting institution with > 3 months of follow up. After a median follow up of 10 months (95% CI = 7-17), Acute genitourinary and gastrointestinal toxicity occurred in 4 (3 G1 and 1 G2), and 5 patients (3 G1 and 2 G2), respectively. Late genitourinary and gastrointestinal toxicity were identified in 7 (all G1) and 1 patient (G2), respectively. BR and CBR were detected at 3 months in 41 (82%) and 23 (46%) cases, respectively. Seven recurrences were detected (3 biochemical and 4 metastatic recurrences detected through PSMA PET-CT) Forty-six patients (92%) were free from ADT at the end of follow up. SSRT yielded optimal results in terms of safety, with only mild adverse events. Biochemical outcomes are promising, with a significant benefit in terms of clinically meaningful outcomes (i.e. new distant metastases occurrence and need for ADT start). [ABSTRACT FROM AUTHOR]

Following reports of improved efficacy in vertebral metastases, Stereotactic Body Radiotherapy has been increasingly applied for local palliation and disease control in non-spinal bone metastases. However, its use in the management of rib metastases (RM) has been traditionally limited due to purported risk of iatrogenic fracture, possibly resulting in impaired pain control. For this reason, SBRT in this setting has been scarcely reported in literature. The aim of our study is to evaluate pain control and local failure rates in RM treated with SBRT. We collected data from a cohort of RM patients treated from October 2014 to December 2023 with SBRT. Clinical and treatment-related data were collected. Pain Control (PC) was defined as absence or reduction of pain allowing for decreased medication intake. Local Failure (LF) was defined as radiologic progression on follow-up imaging. Univariable analysis with the log-rank test and multivariable analysis with the Cox model were performed to investigate predictors of PC and LF. Data from 55 patients accounting for 64 RM were collected. Median age was 70 (range = 37-78) years. Most represented primary tumors were prostate (41%, n = 26) and non-small cell lung cancer (21%, n = 13). Baseline pain before SBRT was reported in 26 (41%) lesions, requiring daily opioid intake in 12 cases (20%). SBRT was delivered with C-arm (92%, n = 59) and robotic-arm (8%, n = 5) Linac using the following regimens: 16 Gy/1 fraction, 24 Gy/2 fractions, 24-30 Gy/3 fractions, 30-55 Gy/5 fractions. Median EQD2 (assuming an α/β = 10) was 47 Gy (range = 35-96.25). Median follow-up was 14 (range = 1-76) months. PC was 87% at 6 months and 82% at 1 year. Age> 70 (P = 0.002), EQD2 ≤40 Gy (P = 0.009) and baseline pain (P = 0.004) were correlated with impaired PC although only EQD2 ≤40 Gy (P = 0.007) and baseline pain (P = 0.012) proved significant at multivariate analysis. LF rate was 2.0% at 6 months and 4.8% at 1 year. Median OS was 60 (95% CI= 25-70) months. No predictive factors of LF were identified at statistical analysis. Pain flare was observed in 1 patient. No rib fracture and/or skin fibrosis was observed. SBRT for RM is associated with low rates of local failure and durable pain control. Administration of SBRT before the onset of symptoms and use dose intensive regimens may result in improved pain control. [ABSTRACT FROM AUTHOR]