前列腺癌（PCa）在放疗和根治性前列腺切除术（RP）后在前列腺区域内再次发生，仍然是难以管理的。评估在此情况下利用营救立体定向放疗（SBRT）再次放疗的疗效和安全性，并评估预后因素。我们在三个国家的11个中心进行了一项大型多中心回顾性研究，其中包括117例接受营救SBRT治疗在RP和放疗后前列腺区域内再次发生的患者。使用Kaplan-Meier方法估计无进展生存期（PFS；生化、临床或两者）；生化复发定义为前列腺特异性抗原最低点+0.2 ng/ml，由第二次上升测量证实。考虑到复发或死亡作为竞争事件，使用Kalbfleisch-Prentice方法估计晚期毒副作用的累积发病率。中位随访时间为19.5个月。中位SBRT剂量为35 Gy。中位PFS为23.5个月（95%置信区间[95% CI]，17.6-33.2）。在多变量模型中，复发的体积及其与尿道膀胱吻合术接触显著影响PFS（危险比[HR]/10 cm3 = 1.46；95% CI，1.08-1.96；p = 0.01及HR = 3.35；95% CI，1.38-8.16；p = 0.008）。3年级≥2级晚期泌尿或胃肠毒副作用的累积发病率为18％（95% CI，10-26）。在多变量分析中，与尿道膀胱吻合术接触的复发和膀胱D2％与任何级别的晚期毒副作用显著相关（HR = 3.65；95% CI，1.61-8.24；p = 0.002及HR/10 Gy = 1.88；95% CI，1.12-3.16；p = 0.02）。营救SBRT治疗前列腺区域内的局部复发可能会提供令人鼓舞的控制效果和可接受的毒副作用。因此，需要进一步进行前瞻性研究。我们发现在手术和放疗后，营救立体定向放疗可以在局部复发的前列腺癌中提供令人鼓舞的控制效果和可接受的毒副作用。版权所有©2023年欧洲泌尿科协会。由Elsevier B.V.出版。保留所有权利。

Management of local recurrence of prostate cancer (PCa) in the prostatic bed after radical prostatectomy (RP) and radiotherapy remains challenging.To assess the efficacy and safety of salvage stereotactic body radiotherapy (SBRT) reirradiation in this setting and evaluate prognostic factors.We conducted a large multicenter retrospective series that included 117 patients who were treated with salvage SBRT for local recurrence in the prostatic bed after RP and radiotherapy in 11 centers across three countries.Progression-free survival (PFS; biochemical, clinical, or both) was estimated using the Kaplan-Meier method. Biochemical recurrence was defined as prostate-specific antigen nadir +0.2 ng/ml, confirmed by a second increasing measure. The cumulative incidence of late toxicities was estimated using the Kalbfleisch-Prentice method by considering recurrence or death as a competing event.The median follow-up was 19.5 mo. The median SBRT dose was 35 Gy. The median PFS was 23.5 mo (95% confidence interval [95% CI], 17.6-33.2). In the multivariable models, the volume of the recurrence and its contact with the urethrovesical anastomosis were significantly associated with PFS (hazard ratio [HR]/10 cm3 = 1.46; 95% CI, 1.08-1.96; p = 0.01 and HR = 3.35; 95% CI, 1.38-8.16; p = 0.008, respectively). The 3-yr cumulative incidence of grade ≥2 late GU or GI toxicity was 18% (95% CI, 10-26). In the multivariable analysis, a recurrence in contact with the urethrovesical anastomosis and D2% of the bladder were significantly associated with late toxicities of any grade (HR = 3.65; 95% CI, 1.61-8.24; p = 0.002 and HR/10 Gy = 1.88; 95% CI, 1.12-3.16; p = 0.02, respectively).Salvage SBRT for local recurrence in the prostate bed may offer encouraging control and acceptable toxicity. Therefore, further prospective studies are warranted.We found that salvage stereotactic body radiotherapy after surgery and radiotherapy allows for encouraging control and acceptable toxicity in locally relapsed prostate cancer.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.