Targeted radiation therapy symbolized by light beams precisely targeting cancer cells.

Targeted Radiation: A Promising Solution for Prostate Cancer Recurrence?

Samir D’Costa in Health & Wellness December 2025 • 4 min read.

"Discover how single-fraction SBRT offers new hope for prostate cancer patients with lymph node relapse, providing effective control with minimal side effects."

Androgen deprivation therapy (ADT) has long been a standard treatment for relapsing prostate cancer after initial surgery or radiation. While effective, ADT often diminishes a patient's quality of life and eventually becomes ineffective as the disease develops resistance. The need for more targeted and less debilitating treatments has driven the exploration of new approaches.

Recent advancements in metabolic imaging now allow for the precise detection of active disease foci, identifying patients with a limited number of metastases (oligometastatic) who could benefit from localized treatments. Stereotactic body radiotherapy (SBRT) has emerged as a viable option for these patients, particularly in cases of lymph node relapse, offering a non-invasive method to precisely target tumors.

This article delves into the findings of a study evaluating the use of single-fraction SBRT for lymph node relapse in oligometastatic prostate cancer. The study assesses the treatment's safety and efficacy, providing insights into its potential as a promising alternative to traditional approaches.

Single-Fraction SBRT: A Targeted Approach

Targeted radiation therapy symbolized by light beams precisely targeting cancer cells.

The study retrospectively analyzed data from 27 treatments performed on 23 patients who underwent single-fraction SBRT for lymph node relapse following previous prostate cancer treatment. The goal was to determine the effectiveness and safety of delivering a high dose of radiation in a single session, contrasting with more common multi-fraction regimens.

Patients included in the study had experienced a biochemical recurrence, confirmed by 18F-choline PET/CT scans showing exclusive lymph nodal oligometastatic relapse (three or fewer metastases) and a controlled primary tumor. The treatment plan involved delivering a 24 Gy dose to the 80% isodose line, resulting in a biologically effective dose (BED) of 216 Gy.

Key inclusion criteria for the study were:

Biochemical recurrence after radical prostatectomy or definitive radiotherapy
Confirmation of exclusive lymph node oligometastatic relapse (≤3 metastases) via 18F-choline PET/CT
Controlled primary tumor

The results indicated promising biochemical control with minimal toxicity. The median follow-up was 22 months. The study reported biochemical progression-free survival (bPFS) rates of 65% at 6 months, 40% at 1 year, and 26% at 2 years. Acute grade 1 toxicity (mild cystitis and diarrhea) was observed in only two cases, resolving spontaneously within 48 hours.

The Future of SBRT in Prostate Cancer Treatment

This study suggests that single-fraction SBRT is a safe and effective treatment option for oligometastatic lymph node recurrence in prostate cancer. The high dose delivered in a single fraction resulted in encouraging biochemical control and minimal side effects, offering a potentially more convenient and less toxic alternative to traditional multi-fraction regimens.

While the results are promising, the authors acknowledge the limitations of their retrospective study, including the small sample size and the lack of a comparator group. Further prospective trials are needed to confirm these findings and to determine the optimal treatment schedule in terms of efficacy, toxicity, and cost-effectiveness.

As interest in local therapeutic options for prostate cancer patients with limited disease burden grows, future research should focus on refining SBRT techniques and identifying the patients who are most likely to benefit from this approach. With further study, single-fraction SBRT could become an important tool in the fight against prostate cancer recurrence.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.1159/000491605, Alternate LINK

Title: Single-Fraction Stereotactic Body Radiotherapy For Oligometastatic Lymph Node Relapse In Prostate Cancer

Subject: Cancer Research

Journal: Oncology Research and Treatment

Publisher: S. Karger AG

Authors: Mauro Loi, Vanessa Di Cataldo, Giulio Francolini, Pierluigi Bonomo, Laura Masi, Gabriele Simontacchi, Beatrice Detti, Daniela Greto, Isacco Desideri, Lorenzo Livi

Published: 2018-01-01

Everything You Need To Know

What is single-fraction SBRT and how does it work?

Single-fraction stereotactic body radiotherapy (SBRT) is a non-invasive treatment that delivers a high dose of radiation in a single session to precisely target tumors, specifically in the case of lymph node relapse. This approach is particularly beneficial for patients with oligometastatic prostate cancer, which means the cancer has spread to a limited number of sites (three or fewer metastases). The study mentioned explores this single-fraction SBRT approach as a treatment for lymph node recurrence, indicating its potential as an alternative to traditional, more extensive radiation therapy.

What is the significance of Androgen deprivation therapy (ADT) in this context?

Androgen deprivation therapy (ADT) is a standard treatment for relapsing prostate cancer. However, ADT can significantly impact a patient's quality of life and often becomes ineffective as the disease progresses. The need for less debilitating and more targeted treatments has driven the exploration of methods like single-fraction SBRT. By precisely targeting the tumors, SBRT aims to control the cancer with fewer side effects and less impact on the patient's overall well-being compared to ADT, which affects the entire body.

How did the study identify suitable patients for single-fraction SBRT?

The study used 18F-choline PET/CT scans to identify patients with oligometastatic lymph node relapse. These scans allow for the precise detection of active disease foci, enabling clinicians to identify patients who could benefit from localized treatments like single-fraction stereotactic body radiotherapy (SBRT). The study included patients with biochemical recurrence after prostatectomy or definitive radiotherapy, exclusive lymph node oligometastatic relapse (three or fewer metastases), and a controlled primary tumor.

What were the main findings of the study regarding single-fraction SBRT?

The study reported biochemical progression-free survival (bPFS) rates of 65% at 6 months, 40% at 1 year, and 26% at 2 years. Additionally, the study showed that acute grade 1 toxicity (mild cystitis and diarrhea) was observed in only two cases, resolving spontaneously within 48 hours. These outcomes suggest that single-fraction stereotactic body radiotherapy (SBRT) provides a promising balance of effectiveness and safety for patients with oligometastatic lymph node relapse.

What are the potential benefits of using single-fraction SBRT for prostate cancer recurrence?

The study highlights that single-fraction stereotactic body radiotherapy (SBRT) can be a safe and effective treatment for prostate cancer patients experiencing lymph node relapse, especially those with oligometastatic disease. This approach delivers a high dose of radiation in a single session, which means fewer treatment sessions, potentially improving patient convenience and reducing the overall burden of treatment. The reduced side effects observed in the study further support the use of SBRT as a viable alternative to traditional treatments like Androgen deprivation therapy (ADT) or multi-fraction radiation regimens.