Retreatment for prostate cancer with stereotactic body radiation therapy (SBRT): Feasible or foolhardy?

tThe most popular therapeutic option in the management of radio-recurrent prostaticcarcinoma is represented by the androgen deprivation therapy, that however should beconsidered only palliative and hampered by potential adverse effects of testosterone sup-pression. Local therapies such as surgery, cryoablation or brachytherapy might be curativechoices for patients in good conditions and with a long-life expectancy, but at cost of sig-nificant risk of failure and severe toxicity. The administration of stereotactic body radiationtherapy (SBRT) in this setting have come about because of tremendous technologic advancesin image guidance and treatment delivery techniques that enable the delivery of large dosesto tumor with reduced margins and high gradients outside the target, thereby reducing thevolume of rectum which already received significant doses from primary radiotherapy. Sofar, very modest data are available to support its employment. Rationale, clinical experience,and challenges are herein reviewed and discussed.