Stereotactic ablative radiotherapy in castration-resistant prostate cancer patients with oligoprogression during androgen receptor-targeted therapy

Ingrosso, Gianluca; Detti, Beatrice; Fodor, Andrei; Caini, Saverio; Borghesi, Simona; Triggiani, Luca; Trippa, Fabio; Russo, Donatella; Bruni, Alessio; Lancia, Andrea; Marinelli, Luca; Muzio, N. Di; Livi, Lorenzo; Magrini, Stefano Maria; Maranzano, Ernesto; Musio, Daniela; Aristei, Cynthia; Valeriani, Maurizio

doi:10.1007/s12094-021-02553-5

Cited by 22 publications

(8 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite toxicity not being an endpoint of the study, no relevant adverse effects according to the Radiation Therapy Oncology Group (RTOG)'s acute and late toxicity grading have been registered. This finding is consistent with data in the literature demonstrating the feasibility of the SBRT and its favorable impact on the patient's quality of life [23,24,26] The standard of care for metastatic prostate cancer patients remains systemic therapy, with a local approach to the metastases reserved for palliative intent; this paradigm is applied both in de novo mPC and in the case of progression during systemic treatment. In recent years, MDT with ablative intent as an approach to oligo-metastatic disease is emerging in different type of cancers, and its role in clinical practice is consolidating.…”

Section: Discussionsupporting

confidence: 88%

Metastasis-Directed Stereotactic Body Radiotherapy in Prostate Cancer Patients Treated with Systemic Therapy and Undergoing Oligoprogression: Report on 11 Consecutive Cases

Chioccola,

Caroprese,

Goodyear

et al. 2024

Radiation

View full text Add to dashboard Cite

Background: Stereotactic body radiotherapy (SBRT) targeted at metastatic sites of disease progression is emerging as a potential therapeutic approach for managing oligoprogressive prostate cancer. However, a definitive benefit has yet to be demonstrated. Herein, we present our institution’s experience with this treatment approach. Methods: From April 2018 to March 2023, 11 patients affected by oligoprogressive prostate cancer were treated with SBRT targeting the nodal or bone sites of progression while maintaining the ongoing systemic therapy. Three patients were undergoing single-agent ADT (Androgen Deprivation Therapy), while the remaining eight were receiving a subsequent line of systemic therapy. All patients were evaluated with a pre-treatment 68Ga-PSMA-11 or 18F-fluorocholine PET/CT, which demonstrated between one and five localizations of disease. All the active sites were treated with SBRT in one (15–24 Gy) or three (21–27 Gy) fractions, except for one patient, who was treated in five fractions (35 Gy). PSA serum levels were tested at baseline, one month after RT and at least every three months; all patients underwent a post-treatment 68Ga-PSMA-11 or 18F-fluorocholine PET/CT. The evaluated endpoints were PSA response, defined as a post-treatment decrease >50% from baseline measured within 6 months, time to next-line systemic treatment (NEST), local control (LC), biochemical progression-free survival (bPFS), radiological progression-free survival (rPFS) and freedom from polymetastatic progression (FPP). Results: Nineteen lesions were treated (seven nodal and twelve bone). At a median follow-up of 19 months (7–63), 9 of the 11 patients had a PSA response; all patients had local control of the treated metastases. A total of six patients switched to a next-line systemic treatment, with a median NEST of 13 months. Six patients had polymetastatic progression with an FPP median time of 19 months. No patients died during the follow-up period. The SBRT-related toxicity was negligible. Conclusions: Our data support the use of SBRT targeting the sites of oligoprogressive disease before moving to a subsequent line of systemic treatment in patients with metastatic prostate cancer. Prospective studies to evaluate the potential impact of this approach on overall survival are warranted.

show abstract

Section: Discussionsupporting

confidence: 88%

Metastasis-Directed Stereotactic Body Radiotherapy in Prostate Cancer Patients Treated with Systemic Therapy and Undergoing Oligoprogression: Report on 11 Consecutive Cases

Chioccola,

Caroprese,

Goodyear

et al. 2024

Radiation

View full text Add to dashboard Cite

show abstract

“…Recently an Italian retrospective multi-institutional analysis of 34 mCRPC patients treated with SBRT to oligoprogressive lesions during ARTT was published ( 36 ). SBRT was delivered to a median total dose of 30 Gy (27–36 Gy) in 3–5 fractions with a BED3>100 Gy in all cases.…”

Section: Discussionmentioning

confidence: 99%

Androgen Receptor Targeted Therapy + Radiotherapy in Metastatic Castration Resistant Prostate Cancer

et al. 2021

View full text Add to dashboard Cite

ObjectivesTo investigate whether radiotherapy as metastasis-directed therapy (MDT) on oligo-progressive sites in metastatic castration-resistant prostate cancer (mCRPC) patients during treatment with androgen receptor-targeted therapy (ARTT) may lead to control resistant lesions, prolonging ARTT. We analysed progression free survival, overall survival and prognostic parameters that can identify patients that best suit to this approach.Patients and MethodsRetrospective analysis of a total of 67 lesions in 42 mCRPC patients treated with ablative or palliative RT to oligoprogressive lesions during ARTT. Twenty-eight patients (67%) underwent ARTT with Abiraterone acetate and 14 patients (33%) underwent ARTT with Enzalutamide. Median time between the start of ADT and ARTT beginning was 50.14 months (range 3.37-219 months). We treated 58 lesions (87%) with 3D conformal radiotherapy (3DCRT) and nine lesions (13%) with stereotactic body radiotherapy (SBRT). The Kaplan Meier method was used to assess the median overall survival (OS) and the progression-free survival (PFS).ResultsMedian follow-up was 28 months (range 3-82 months). Median OS was 32.5 months (95% CI 25.77-39.16), 1 and 2-year OS were 71.6% and 64.1%, respectively. Median PFS was 19,8 months (95% CI 11.34–28.31), 1 and 2-year PFS were 67.2% and 47.4%, respectively. Median OS for patients that underwent radiotherapy before 6 months from the start of ARTT was 23.4 months (95% CI 2.04-44.89) and 45.5 months (95% CI 31.19-59.8) for patients that underwent radiotherapy after 6 months (p = 0.009).ConclusionLocal ablative radiation therapy directed to progressive metastasis is a non-invasive, well tolerated treatment with efficacy on prolonging clinical benefit of systemic therapies with ARTT. Patients who underwent RT >6 months from the start of ARTT presented a statistically better OS and PFS compared with patients who underwent radiotherapy <6 months from the start of ARTT.

show abstract

“…Several trials (namely, TRANSFORM, ORIOLE, and CORE) are exploring the utility of SABR-based MDT in oligometastatic prostate cancer. For oligo-recurrences in CRPC, SABR has helped yield “next line systemic therapy”-free survival of 16–21.8 months in retrospective series, which is encouraging [ 6 , 7 ]. Elective nodal RT for involved nodal region has higher toxicity than SABR to involved node only, but it is still unclear whether it is more effective than SABR [ 8 , 9 ].…”

mentioning

confidence: 99%

Stereotactic ablative body radiotherapy for oligometastatic inguinal lymph node in castrate resistant prostate cancer

Goyal

Periasamy

Madan

et al. 2023

Asian Journal of Urology

View full text Add to dashboard Cite

Stereotactic ablative radiotherapy in castration-resistant prostate cancer patients with oligoprogression during androgen receptor-targeted therapy

Cited by 22 publications

References 34 publications

Metastasis-Directed Stereotactic Body Radiotherapy in Prostate Cancer Patients Treated with Systemic Therapy and Undergoing Oligoprogression: Report on 11 Consecutive Cases

Metastasis-Directed Stereotactic Body Radiotherapy in Prostate Cancer Patients Treated with Systemic Therapy and Undergoing Oligoprogression: Report on 11 Consecutive Cases

Androgen Receptor Targeted Therapy + Radiotherapy in Metastatic Castration Resistant Prostate Cancer

Stereotactic ablative body radiotherapy for oligometastatic inguinal lymph node in castrate resistant prostate cancer

Contact Info

Product

Resources

About