Radiotherapy as metastasis-directed therapy for oligometastatic prostate cancer

Bleser, Elise De; Tran, Phuoc T.; Ost, Piet

doi:10.1097/mou.0000000000000441

Cited by 38 publications

(37 citation statements)

References 44 publications

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“…When one compares the present SLND cohort to groups who studied explicitly patients staged with PSMA PET/CT, one-year progression-free survival (PFS) ranged from 23 to 64%, with higher PFS found in patients with a radio-guided SLND approach [4,[28][29][30] indicating that this might further allow the dissection of affected lymph nodes that had not been visualized beforehand on PET/CT. Overall, bRFS of the present SLND cohort compares nicely to this range and similar PFS ranges are known for SBRT cohorts [5].…”

Section: Discussionsupporting

confidence: 76%

“…Likewise, few studies on SLNRT were identified in a recent review: Patients with pelvic and/or extra-pelvic nodes were either treated by stereotactic body radiotherapy (SBRT) (55%) or elective nodal radiotherapy (ENRT) (45%) to a lymph node region or the whole pelvic lymphatic pathways [5]. In patients treated with ENRT 3-year progression-free survival ranged from 61.8 to 75% [6], whereas in patients with SBRT to PET-positive lymph nodes 3-year progression-free survival ranged between 26 and 33% [5]. This is strikingly comparable to outcome data achieved by SLND, although one has to reconsider that the majority of patients in the reported studies were staged at best with choline positron emission tomography/computer tomography (PET/CT) thus underestimating the true extent of nodal recurrence.…”

Section: Introductionmentioning

confidence: 99%

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PSMA-positive nodal recurrence in prostate cancer

et al. 2020

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Purpose This analysis compares salvage lymph node dissection (SLND) to salvage lymph node radiotherapy (SLNRT) of 68 Ga-PSMA PET-positive nodal recurrences after radical prostatectomy (RPE). Methods A total of 67 SLNRT and 33 SLND consecutive patients with pelvic and/or para-aortic nodal recurrences after RPE were retrospectively analyzed. Biochemical recurrence-free survival rates (bRFS; PSA <0.2 ng/mL) were calculated according to Kaplan-Meier and survival curves were compared using the log rank test. For multivariable analysis, binary logistic regression analysis was performed (p < 0.05). Results Median follow-up was 17 months (range, 6-53 months) in SLND patients and 31 months (range, 3-56 months) in SLNRT patients (p = 0.027). SLNRT patients had significantly more tumours of pT3 and pT4 category (82% vs. 67%; p = 0.006), pathologically involved lymph nodes (45% vs. 27%; p = 0.001) and positive surgical margins (54% vs. 12%; p = 0.001) at time of RPE than SLND patients. PSA persistence after RPE was significantly more frequently observed in the SLNRT cohort (73% vs. 27%; p = 0.001). There was no significant difference in the distribution of PET-positive lymph nodes. Median PSA before SLND was higher than before SLNRT (3.07 ng/ml vs. 1.3 ng/ml; p = 0.393). The 2-year bRFS was significantly higher in the SLNRT vs. the SLND cohort (92% vs. 30%; p = 0.001) with lower rates of distant metastases (21% vs. 52%; p = 0.002) and secondary treatments (5% vs. 39%; p = 0.011) irrespective of ongoing androgen deprivation therapy at last contact. In multivariable analysis, SLNRT was significantly associated with prolonged bRFS (regression coefficient 1.436, hazard ratio 4.204, 95% CI 1.789-9.878; p = 0.001). Conclusion Based on this retrospective study SLNRT might be the preferred treatment option for patients with nodal recurrence after previous RPE.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

PSMA-positive nodal recurrence in prostate cancer

et al. 2020

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“…Benefit is primarily gained in patients treated for multiple lymph node oligometastases: geometrical deformations are accounted for, dose can be delivered in one plan and margins can be reduced. In recent years stereotactic body radiation therapy (SBRT) has become the standard treatment option for the treatment of patients with lymph node oligometastases in many centers [1,2]. SBRT allows for the delivery of a relatively high amount of dose in few fractions with a very steep dose gradient [3] and is often given to postpone the start of systematic therapy and improve progression-free or overall survival without compromising the quality of life [4,5].…”

Section: Introductionmentioning

confidence: 99%

Target coverage and dose criteria based evaluation of the first clinical 1.5T MR-linac SBRT treatments of lymph node oligometastases compared with conventional CBCT-linac treatment

Winkel

Bol

Werensteijn-Honingh

et al. 2020

Radiotherapy and Oncology

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a b s t r a c tBackground and purpose: Patients were treated at our institute for single and multiple lymph node oligometastases on the 1.5T MR-linac since August 2018. The superior soft-tissue contrast and additional software features of the MR-linac compared to CBCT-linacs allow for online adaptive treatment planning. The purpose of this study was to perform a target coverage and dose criteria based evaluation of the clinically delivered online adaptive radiotherapy treatment compared with conventional CBCT-linac treatment. Materials and methods: Patient data was used from 14 patients with single lymph node oligometastases and 6 patients with multiple (2-3) metastases. All patients were treated on the 1.5T MR-linac with a prescribed dose of 5 Â 7 Gy to 95% of the PTV and a CBCT-linac plan was created for each patient. The difference in target coverage between these plans was compared and plans were evaluated based on dose criteria for each fraction after calculating the CBCT-plan on the daily anatomy. The GTV coverage was evaluated based on the online planning and the post-delivery MRI. Results: For both single and multiple lymph node oligometastases the GTV V 35Gy had a median value of 100% for both the MR-linac plans and CBCT-plans pre-and post-delivery and did not significantly differ. The percentage of plans that met all dose constraints was improved from 19% to 84% and 20% to 67% for single and multiple lymph node cases, respectively. Conclusion: Target coverage and dose criteria based evaluation of the first clinical 1.5T MR-linac SBRT treatments of lymph node oligometastases compared with conventional CBCT-linac treatment shows a smaller amount of unplanned violations of high dose criteria. The GTV coverage was comparable. Benefit is primarily gained in patients treated for multiple lymph node oligometastases: geometrical deformations are accounted for, dose can be delivered in one plan and margins can be reduced.

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“…There is a growing interest in treating oligorecurrent patients with a metastasis-directed approach aiming to postpone disease progression and the need for definitive, palliative ADT. Metastasis-directed therapy (MDT) by means of surgery or radiotherapy has already been widely evaluated in several retrospective analyses [3,4]. To date, only one prospective randomized trial, the Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence (STOMP) trial, evaluated the effect of MDT versus surveillance in PCa [5], where MDT was either performed via surgery or via stereotactic body radiotherapy (SBRT) to the metastatic lesion(s).…”

Section: Introductionmentioning

confidence: 99%

A Trial-Based Cost-Utility Analysis of Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer

Bleser

Willems

Decaestecker

et al. 2020

Cancers

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The optimal management of patients with oligorecurrent prostate cancer (PCa) is unknown. There is growing interest in metastasis-directed therapy (MDT) for this population. The objective was to assess cost-utility from a Belgian healthcare payer’s perspective of MDT and delayed androgen deprivation therapy (ADT) in comparison with surveillance and delayed ADT, and with immediate ADT. A Markov decision-analytic trial-based model was developed, projecting the results over a 5-year time horizon with one-month cycles. Clinical data were derived from the STOMP trial and literature. Treatment costs were derived from official government documents. Probabilistic sensitivity analyses showed that MDT is cost-effective compared to surveillance (ICER: €8393/quality adjusted life year (QALY)) and immediate ADT (dominant strategy). The ICER is most sensitive to utilities in the different health states and the first month MDT cost. At a willingness-to-pay threshold of €40,000 per QALY, the cost of the first month MDT should not exceed €8136 to be cost-effective compared to surveillance. The Markov-model suggests that MDT for oligorecurrent PCa is potentially cost-effective in comparison with surveillance and delayed ADT, and in comparison with immediate ADT.

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Radiotherapy as metastasis-directed therapy for oligometastatic prostate cancer

Abstract: Based on data from retrospective studies, progression-free survival following MDT for oligometastatic PCa is promising with few adverse events. Comparative prospective studies are under way and will shed light on the future of MDT.

Cited by 38 publications

References 44 publications

PSMA-positive nodal recurrence in prostate cancer

PSMA-positive nodal recurrence in prostate cancer

Target coverage and dose criteria based evaluation of the first clinical 1.5T MR-linac SBRT treatments of lymph node oligometastases compared with conventional CBCT-linac treatment

A Trial-Based Cost-Utility Analysis of Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer

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