FALCON Workshop focuses on salvage intra-prostatic relapses

05 December 2016

The European SocieTy for Radiotherapy & Oncology (ESTRO) organised the educational and multifunctional FALCON (Fellowship in Anatomic delineation and CONtouring) Workshop during the recently concluded 8th European Multidisciplinary Meeting on Urological Cancers (EMUC16). This year’s FALCON Workshop was a delineation contouring workshop focused on salvage intraprostatic relapses.

Radiation oncologists FALCON Chair Dr. A. Bossi of the Institut Gustave Roussy (Villejuif, France), Dr. B.R. Pieters of the Academisch Medisch Centrum (Amsterdam, Netherlands), Prof. B.A. Jereczek-Fossa of the European Institute of Oncology (Milan, Italy), and Dr. B. de Bari of the Hôpital Jean Minjoz (Besançon, France) led the workshop.

“Not all patients presenting with a rising prostate-specific antigen (PSA) and positive prostate biopsy are treatable with or are good candidates of salvage local therapy,” said Bossi. He enumerated factors to be considered for salvage local therapy such as determining if the initial cancer (before radiation) is curable: T1-3a N0 M0; or if the current cancer T1-3a, PSA < 10 -15 has no evidence of metastases and has positive re-biopsy. Bossi added that the patient should be in good health with a life expectancy of more than five years, highly motivated and willing to accept the risks of salvage therapy. There should be no evidence of severe radiation cystitis or proctitis. Bossi states, “From our point of view as radiation oncologists, it is very unlikely that the patient with severe cystitis or proctitis would be a good candidate for salvage intra-prostatic treatment.”

FALCON collage

Bossi cited multiple studies with regard to the reasons for intra-prostatic relapse: presence of so-called radiation-resistant prostate cancer clones; sub-optimal total dose in the prostate; “geographical misses”; while the rationale for salvage is related to an increased risk of metastasis and death from cancer; and finally, increased risk for local complication in terms of bladder outlet obstruction, obstructive uropathy, intractable haematuria and pelvic pain.

The FALCON Workshop began with an explanation of how to use the contouring software. Then a clinical case was presented by Pieters and afterwards each participant was asked to perform a delineation of the volume to be treated. After the round of contouring, Jereczek-Fossa presented the delineation guidelines and a second round of contouring followed soon after. The workshop closed with a discussion between experts and participants.

The FALCON Workshop was aimed at junior clinical or radiation oncologists who want to improve their contouring skills, and senior specialists who want to refresh their knowledge and skills in this field. Participants were given the opportunity to practice contouring then compare their results with those from the experts and other participants. The use of the delineation guidelines were communicated as well in order for them to integrate said guidelines and what they have learned during the workshop into their daily practice.