Abstract
Purpose
Herein, we report the clinical outcomes of a multicenter study evaluating the role of SBRT in a cohort of patients affected by oligoprogressive castration-resistant prostate cancer (CRPC).
Materials and methods
This is a retrospective multicenter observational study including eleven centers. Inclusion criteria of the current study were: (a) Karnofsky performance status > 80, (b) histologically proven diagnosis of PC, (c) 1–5 oligoprogressive metastases, defined as progressive disease at bone or nodes levels (detected by means of choline PET/CT or CT plus bone scan) during ADT, (d) serum testosterone level under 50 ng/ml during ADT, (e) controlled primary tumor, (f) patients treated with SBRT with a dose of at least 5 Gy per fraction to a biologically effective dose (BED) of at least 80 Gy using an alpha-to-beta ratio of 3 Gy, (g) at least 6 months of follow-up post-SBRT.
Results
Eighty-six patients for a total of 117 lesions were treated with SBRT. The median follow-up was 30.7 months (range 4–91 months). The median new metastasis-free survival after SBRT was 12.3 months (95% CI 5.5–19.1 months). One- and two-year distant progression-free survival was 52.3% and 33.7%, respectively. Twenty-six out of 86 patients underwent a second course of SBRT due to further oligoprogressive disease: This resulted in a median systemic treatment-free survival of 21.8 months (95% CI 17.8–25.8 months). One-year systemic treatment-free survival was 72.1%.
Conclusion
SBRT appears to be a promising approach in oligoprogressive castration-resistant prostate cancer. Further investigations are warranted.
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References
Cornford P, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration resistant prostate cancer. Eur Urol 71:630–642
Tannock IF, de Wit R, Berry WR et al (2004) Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 351:1502–1512
Ryan CJ, Smith MR, de Bono JS et al (2013) Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med 368:138–148
Ryan CJ, Smith MR, Fizazi K et al (2015) Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol 16:152–160
Beer TM, Armstrong AJ, Rathkopf DE et al (2014) Enzalutamide in metastatic prostate cancer before chemotherapy. N Engl J Med 371:424–433
de Bono JS, Logothetis CJ, Molina A et al (2011) Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med 364:1995–2005
Fizazi K, Scher HI, Molina A et al (2012) Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol 13:983–992
Scher HI, Fizazi K, Saad F et al (2012) Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med 367:1187–1197
Oudard S, Fizazi K, Sengeløv L et al (2017) Cabazitaxel versus docetaxel as first-line therapy for patients with metastatic castration-resistant prostate cancer: a randomized phase III trial-FIRSTANA. J Clin Oncol 35:3189–3197
Triggiani L, Alongi F, Buglione M et al (2017) Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study. Br J Cancer 116:1520–1525
Ost P, Bossi A, Decaestecker K et al (2015) Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol 67:852–863
Fanetti G, Marvaso G, Ciardo D et al (2018) Stereotactic body radiotherapy for castration-sensitive prostate cancer bone oligometastases. Med Oncol 35:75
Ponti E, Lancia A, Ost P et al (2017) Exploring all avenues for radiotherapy in oligorecurrent prostate cancer disease limited to lymph nodes: a systematic review of the role of stereotactic body radiotherapy. Eur Urol Focus 3(6):538–544
Jereczek-Fossa BA, Beltramo G et al (2012) Robotic image-guided stereotactic radiotherapy, for isolated recurrent primary, lymph node or metastatic prostate cancer. Int J Radiat Oncol Biol Phys 82:889–897
Decaestecker K, De Meerleer G, Lambert B et al (2014) Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence. Radiat Oncol 9:135
Ost P, Reynders D, Decaestecker K et al (2018) Surveillance or metastasis directed therapy for oligometastatic prostate cancer recurrence: a prospective, randomized, multicenter phase II trial. J Clin Oncol 36:446–453
De Bruycker A, Lambert B, Claeys T et al (2017) Prevalence and prognosis of low-volume, oligorecurrent, hormone-sensitive prostate cancer amenable to lesion ablative therapy. BJU Int 120:815–821
Wahl RL, Jacene H, Kasamon Y et al (2009) From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 50:122S–150S
Harris WP, Mostaghel EA, Nelson PS et al (2009) Androgen deprivation therapy: progress in understanding mechanisms of resistance and optimizing androgen depletion. Nat Clin Pract Urol 6:76–85
Boevé LMS, Hulshof MCCM, Vis AN et al (2018) Effect on survival of androgen deprivation therapy alone compared to androgen deprivation therapy combined with concurrent radiation therapy to the prostate in patients with primary bone metastatic prostate cancer in a prospective randomised clinical trial: data from the HORRAD trial. Eur Urol 75:410–418
Parker CC, James ND, Brawley CD et al (2018) Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 392(10162):2353–2366
Palma DA, Haasbeek CJ, Rodrigues GB et al (2012) Stereotactic ablative radiotherapy for comprehensive treatment of oligometastatic tumors (SABR-COMET): study protocol for a randomized phase II trial. BMC Cancer 12:305
Mazzola R, Fersino S, Ferrera G et al (2018) Stereotactic body radiotherapy for lung oligometastases impacts on systemic treatment-free survival: a cohort study. Med Oncol 35(9):121
Correa RJ, Salama JK, Milano MT et al (2016) Stereotactic body radiotherapy for oligometastasis: opportunities for biology to guide clinical management. Cancer J 22(4):247–256
Ost P, Jereczek-Fossa BA, Van As N, Zilli T et al (2016) Pattern of progression after stereotactic body radiotherapy for oligometastatic prostate cancer nodal recurrences. Clin Oncol (R Coll Radiol) 28:e115–e120
De Bari B, Alongi F, Lestrade L, Giammarile F (2014) Choline-PET in prostate cancer management: the point of view of the radiation oncologist. Crit Rev Oncol Hematol 91(3):234–247
Alongi F, Fersino S, Giaj Levra N et al (2015) Impact of 18F-choline PET/CT in the decision-making strategy of treatment volumes in definitive prostate cancer volumetric modulated radiation therapy. Clin Nucl Med 40(11):e496–e500
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LT, RM and SMM took part in project development. All the authors were involved in data collection and manuscript writing.
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Triggiani, L., Mazzola, R., Magrini, S.M. et al. Metastasis-directed stereotactic radiotherapy for oligoprogressive castration-resistant prostate cancer: a multicenter study. World J Urol 37, 2631–2637 (2019). https://doi.org/10.1007/s00345-019-02717-7
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DOI: https://doi.org/10.1007/s00345-019-02717-7