Stereotactic Re-irradiation in Recurrent Prostate Cancer after Previous Postoperative or Definitive Radiotherapy: Long-term Results after a Median Follow-up of 4 Years.

AIMS: In 2018, we published early results from a cohort of patients treated with stereotactic body radiotherapy (SBRT) after previous radiotherapy with definitive or postoperative intent. We sought to provide extended follow-up of this cohort to confirm the safety and efficacy of this approach in a real-world scenario. MATERIALS AND METHODS: Fifty patients affected by local relapse after previous definitive or postoperative radiotherapy were treated with SBRT. Treatment provided a total dose of 30 Gy in five fractions. Data about biochemical relapse-free survival (BRFS) and metastasis-free survival (MFS), together with adverse events, were analysed. Toxicity was reported according to Common Terminology Criteria for Adverse Events (CTCAE) score v.4.03. RESULTS: After a median follow-up of 48.2 months, the median BRFS was 43 months. A Gleason score >7 and concomitant androgen deprivation therapy were shown to be predictors of the worst BRFS (hazard ratio 2.42, 95% confidence interval 1.09-5.41, P = 0.02; hazard ratio 2.83, 95% confidence interval 1.17-6.8, P = 0.02, respectively). The median MFS was not reached; concomitant androgen deprivation therapy was confirmed to be predictive of the worst MFS (hazard ratio 4.75, 95% confidence interval 1.52-14.8, P = 0.007). Late grade 1 and 2 rectal and bladder toxicity occurred in three (6%) and 13 (26%) patients, respectively. One patient experienced both grade 3 acute and chronic bladder toxicity. CONCLUSION: Salvage SBRT re-irradiation after previous postoperative or definitive radiotherapy for local prostate cancer recurrence confirmed promising results in terms of oncological outcomes and the safety of this approach.

Sea-ice algal phenology in a warmer Arctic.

The Arctic sea-ice decline is among the most emblematic manifestations of climate change and is occurring before we understand its ecological consequences. We investigated future changes in algal productivity combining a biogeochemical model for sympagic algae with sea-ice drivers from an ensemble of 18 CMIP5 climate models. Model projections indicate quasi-linear physical changes along latitudes but markedly nonlinear response of sympagic algae, with distinct latitudinal patterns. While snow cover thinning explains the advancement of algal blooms below 66°N, narrowing of the biological time windows yields small changes in the 66°N to 74°N band, and shifting of the ice seasons toward more favorable photoperiods drives the increase in algal production above 74°N. These diverse latitudinal responses indicate that the impact of declining sea ice on Arctic sympagic production is both large and complex, with consequent trophic and phenological cascades expected in the rest of the food web.