Prostate cancer has a high frequency of relapse, and the relapse is usually associated with a nodal recurrence pattern. This meta-analysis determined the safety and survival of salvage body stereotactic radiotherapy (SBRT) in oligo-recurrent nodal prostate cancer patients.

We searched the Cochrane Central, PubMed, ClinicalTrials.gov, and Google Scholar to retrieve the relevant randomized controlled trials (RCTs) from inception to May 2024. Dichotomous outcomes were pooled using risk ratios (RR) with a 95% confidence interval (CI), while survival outcomes using hazard ratios (HR).

Three RCTs with a total of 312 patients (median age range of >18-79) were included. 135 received SBRT with medical therapy, while 122 underwent either observation, medical therapy, or elective nodal radiotherapy. SBRT significantly increased the biochemical recurrence-free survival (HR: 0.45; 95% CI, 0.28-0.73) with minimal heterogeneity (I2 = 0%). SBRT did not affect the grade 2 genitourinary (GU) toxicity (Common Terminology Criteria for Adverse Events [CTCAE] v4.0 (RR: 0.74; 95% CI, 0.32-1.70; (I2 = 0%) nor the grade 2 gastrointestinal (GI) toxicity (CTCAE v4.0) (RR: 1.05; 95% CI, 0.26-4.31; I2 = 0%). There was no significant change in the grade 1 toxicity (CTCAE v4.0) (RR, 1.08; 95% CI, 0.62-1.89) with moderate heterogeneity (I2 = 63%).

SBRT improves biochemical recurrence-free survival in patients with oligo-recurrent prostate cancer without increasing grade 1 and grade 2 GU/GI toxicity levels.