Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study

Triggiani, Luca; Alongi, Filippo; Buglione, Michela; Detti, Beatrice; Santoni, Riccardo; Bruni, Alessio; Maranzano, Ernesto; Lohr, Frank; D’Angelillo, Rolando Maria; Magli, A.; Bonetta, Alberto; Mazzola, Rosario; Pasinetti, Nadia; Francolini, Giulio; Ingrosso, Gianluca; Trippa, Fabio; Fersino, S.; Borghetti, Paolo; Ghirardelli, Paolo; Magrini, Stefano Maria

doi:10.1038/bjc.2017.103

Cited by 126 publications

(106 citation statements)

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“…The exclusion reasons with references are listed in Data S2. Finally, 14 articles were selected for data extraction and subsequent qualitative synthesis.…”

Section: Resultsmentioning

confidence: 99%

“…One randomized controlled trial was found, but it did not meet all the eligibility criteria, so it was not included in the qualitative analysis . Thirteen articles were single‐arm case series/cohort studies, and one case–control series, with five (36%) prospective and nine (64%) retrospective researches . Median follow‐up period varied from 10.2 to 36.6 months (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Choline PET/CT was the most commonly used evaluation method and was present in all the studies . However, six of them allowed its substitution for less accurate tests (18F‐FDG PET/CT, MRI, CT and/or Bone Scan) in a minority of patients (<5%). The use of PSMA PET/CT was reported in only 1% of the patients …”

Section: Resultsmentioning

confidence: 99%

“…The use of other systemic therapies was not patterned either. Prophylactic pelvic irradiation at the time of SBRT was reported in 2% of the patients …”

Section: Resultsmentioning

confidence: 99%

“…Toxicity was assessed according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria in six (43%) studies and the Common Terminology Criteria for Adverse Events (CTCAE) in five (35%) others . Three (21%) articles did not describe the criteria adopted …”

Section: Resultsmentioning

confidence: 99%

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Use of stereotactic body radiation therapy for oligometastatic recurrent prostate cancer: A systematic review

et al. 2018

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The purpose of this study is to evaluate the effectiveness and safety of stereotactic body radiation therapy (SBRT) in the management of oligometastatic recurrent prostate cancer (PCa) by means of a systematic review. Six databases were searched (CENTRAL, Embase, LILACS, PubMed, Scopus and Web of Science). Additionally, hand-searching and grey literature search were performed. The main outcomes were progression-free survival (PFS) and toxicity rates. Androgen deprivation therapy-free survival (ADT-FS), local control, pattern of recurrence, cancer-specific survival and overall survival were also assessed. Risk of bias and quality of evidence were judged with the aid of specific tools. Fourteen studies were included, involving 661 patients and 899 lesions (561 nodal, 336 bone, 2 liver). Median PFS and ADT-FS were around 1 to 3 years. Local control rates varied from 82 to 100% among researches with low risk of bias. Acute and late grade 2 toxicity was observed in 2.4% and 1.1% of the patients, respectively. One case of acute and two cases of late grade 3 toxicity were registered. Only one randomized study addresses this topic. Although it does not meet all the eligibility criteria, it is useful for the discussion. A quantitative analysis was not possible, nor were subgroup analyses, due to the significant heterogeneity of the interventions and outcomes reported. Longer follow-up period is required. SBRT seems to be a safe approach to metastatic lesions that might provide disease control and defer androgen deprivation therapy (ADT). Local control is better when higher radiation doses are employed.

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“…The exclusion reasons with references are listed in Data S2. Finally, 14 articles were selected for data extraction and subsequent qualitative synthesis.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The use of other systemic therapies was not patterned either. Prophylactic pelvic irradiation at the time of SBRT was reported in 2% of the patients …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Use of stereotactic body radiation therapy for oligometastatic recurrent prostate cancer: A systematic review

et al. 2018

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Single‐fraction image‐guided robotic radiosurgery efficiently controls local prostate cancer recurrence after radical prostatectomy

et al. 2020

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Purpose To assess the therapeutic potential of single‐fraction robotic stereotactic ablative body radiotherapy (SABR) in patients with locally recurrent prostate cancer (PC) after radical prostatectomy (RP). Materials and methods We included 35 patients with biochemical failure after RP with single‐site local recurrence in the prostate bed diagnosed by PSMA PET/CT. About 20/35 pts had previously received post‐surgical adjuvant radiation therapy. High‐resolution multiparametric magnetic resonance imaging (mpMRI) for exact visualization of tumor tissue was performed at 1.5 (n = 23; Siemens Magnetom Aera) or 3 Tesla (n = 12; Siemens Magnetom VIDA, Siemens Healthineers, Erlangen, Germany). Using the MRI and PET/CT dataset for planning, SABR was carried out after ultrasound‐guided placement of a single gold fiducial marker at the site of tumor recurrence using a CyberKnife M6 unit (Accuray Inc., Sunnyvale, USA). Due to the high diagnostic accuracy of PSMA PET/CT and mpMRI, pre‐SABR biopsy of tumor tissue was not deemed necessary. PSMA PET/CT performed in median 88 days before SABR confirmed the absence of distant metastases. MpMRI was performed at a median of 22 days prior to the intervention. SABR was performed in a single fraction with a dose of 20 (5/35), 21 (27/35) or 22 (3/35) Gy. Follow‐up serum PSA was measured every 3 months thereafter. Results Median patient age was 72 years (57‐80 years) and median time from RP to SABR was 96.8 months (IQR, 69.3‐160.2). Median serum PSA before SABR was 1.38 ng/mL (IQR 0.75‐2.72). At 3 months, median PSA had dropped significantly in 27/35 patients to a median of 0.35 ng/mL (IQR 0.25‐0.68). At 6 months, 30/35 patients showed biochemical response to SABR, while five patients were progressing: three had systemic disease on PSMA PET/CT, while two patients had rising PSA values without a visible correlate on PET/CT. The median follow‐up time was 16 months. Grade 1 genitourinary (GU) toxicity was reported in 3/35 patients (9%) and grade 1 gastrointestinal (GI) toxicity in 2/35 patients (6%), respectively. Conclusion SABR is an efficient new treatment option in the management of single‐site local recurrent PC without the evidence of systemic disease; due to its very low toxicity, it is an alternative to surgical re‐treatment or other focal therapies. It can significantly delay the onset of androgen deprivation therapy (ADT) in biochemical failure after radical prostatectomy.

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Oligometastatic prostate cancer: Reality or figment of imagination?

Foster

Weichselbaum

Pitroda

2018

Cancer

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The term “oligometastatic prostate cancer” refers to a heterogeneous group of disease states currently defined solely on the basis of clinical features. Oligorecurrent disease, de novo oligometastases, and oligoprogressive disease likely have unique biologic underpinnings and natural histories. Evidence suggesting the existence of a subset of patients who harbor prostate cancer with limited metastatic potential currently includes disparate and overwhelmingly retrospective reports. Nevertheless, emerging prospective data have corroborated the “better‐than‐expected,” retrospectively observed outcomes, particularly in the setting of oligorecurrent prostate cancer. Improved functional imaging with prostate‐specific membrane antigen‐targeted strategies may enhance the identification of patients with oligometastatic prostate cancer in the short term. In the long term, refinement of the oligometastatic case definition likely will require biologic risk‐stratification schemes. To determine optimal treatment strategies and identify patients most likely to benefit from metastasis‐directed therapy, future efforts should focus on conducting high‐quality, prospective trials with much‐needed molecular correlative studies.

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Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study

Cited by 126 publications

References 21 publications

Use of stereotactic body radiation therapy for oligometastatic recurrent prostate cancer: A systematic review

Use of stereotactic body radiation therapy for oligometastatic recurrent prostate cancer: A systematic review

Single‐fraction image‐guided robotic radiosurgery efficiently controls local prostate cancer recurrence after radical prostatectomy

Oligometastatic prostate cancer: Reality or figment of imagination?

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