Salvage radiotherapy is a specialized approach within cancer care, used when initial treatment has not fully eradicated the disease or when cancer recurs. This form of radiation therapy is a subsequent intervention, distinct from primary treatment. It aims to manage or eliminate persistent or returning cancer.
Understanding Salvage Radiotherapy
The term “salvage” signifies an effort to regain control after initial treatment. Unlike primary radiation for newly diagnosed cancer or adjuvant therapy given immediately after primary treatment, salvage radiotherapy is considered when original therapy, like surgery or primary radiation, has not fully eradicated the cancer or when the disease reappears.
This approach is necessary when cancer cells remain or return, detected via biomarkers or imaging. For example, a rising Prostate-Specific Antigen (PSA) level after prostate cancer surgery indicates biochemical recurrence, prompting salvage therapy. The goal is to achieve local control by eliminating persistent or recurrent cancer cells, thereby preventing further spread or progression. This strategy aims to provide a chance for long-term disease control.
When It Is Applied
Salvage radiotherapy is considered when localized recurrence or persistent disease is identified after initial treatment. A common application is in prostate cancer, where a rise in Prostate-Specific Antigen (PSA) levels after radical prostatectomy indicates biochemical recurrence. This treatment targets the prostate bed and sometimes surrounding lymph node tissue. Early intervention, often when PSA levels are low (e.g., ≥0.2 ng/mL), can improve treatment effectiveness.
Its application extends to other cancers, such as certain head and neck or rectal cancers, where localized recurrence might occur after surgery or primary radiation. Patient selection involves assessing the cancer’s extent and location, previous treatments, and overall health. Imaging tests (CT, MRI, PET scans) help identify the recurrence’s precise location to determine if salvage radiotherapy is appropriate.
How Treatment is Delivered
Salvage radiotherapy delivery involves a precise process to target cancer while minimizing healthy tissue exposure. It begins with an initial consultation and advanced imaging (CT, MRI, PET scans) to create detailed 3D maps of the treatment area. These images accurately localize recurrent or persistent disease.
A specialized team uses these images to develop a personalized treatment plan, or simulation, determining radiation beam angles, shapes, and intensities. Modern techniques like Intensity-Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation Therapy (SBRT) are often employed. These technologies allow highly conformal radiation delivery, shaping the dose to tumor contours while sparing nearby organs. Delivery typically occurs over several weeks, with daily sessions five days per week.
Navigating Treatment and Beyond
Patients typically undergo daily treatment sessions, lasting a few minutes, over several weeks. The course often spans four to eight weeks, with treatments administered five days a week. Patients lie on a treatment couch as a machine delivers the generally painless radiation. During this period, patients may experience temporary physical responses.
Responses can include fatigue or changes in bowel or urinary habits, depending on the treated area. These are manageable with supportive care and typically resolve in the weeks and months following therapy. After treatment, regular follow-up care monitors recovery and assesses effectiveness. This includes ongoing imaging and blood tests to track the disease, with the aim of achieving long-term control or an improved quality of life.