Recurrence pattern of stereotactic body radiotherapy in oligometastatic prostate cancer: a multi-institutional analysis

Nicosia, Luca; Franzese, Ciro; Mazzola, Rosario; Franceschini, Davide; Rigo, Michele; D'Agostino, Giuseppe Roberto; Corradini, Stefanie; Alongi, Filippo; Scorsetti, Marta

doi:10.1007/s00066-019-01523-9

Cited by 32 publications

(20 citation statements)

References 24 publications

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“…Curative or oligometastatic treatment concept was defined as locally curative treatment ( 16 ) of all tumor sites with local curative doses being defined as exceeding an equivalent total dose in 2 Gy fractions (EQD2, alpha/beta = 2) of 50 Gy. Patients who had disseminated disease and those treated with palliative intent were excluded.…”

Section: Methodsmentioning

confidence: 99%

The Distribution of Pelvic Nodal Metastases in Prostate Cancer Reveals Potential to Advance and Personalize Pelvic Radiotherapy

et al. 2021

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BackgroundTraditional clinical target volume (CTV) definition for pelvic radiotherapy in prostate cancer consists of large volumes being treated with homogeneous doses without fully utilizing information on the probability of microscopic involvement to guide target volume design and prescription dose distribution.MethodsWe analyzed patterns of nodal involvement in 75 patients that received RT for pelvic and paraaortic lymph node metastases (LNs) from prostate cancer in regard to the new NRG-CTV recommendation. Non-rigid registration-based LN mapping and weighted three-dimensional kernel density estimation were used to visualize the average probability distribution for nodal metastases. As independent approach, the mean relative proportion of LNs observed for each level was determined manually and NRG and non-NRG levels were evaluated for frequency of involvement. Computer-automated distance measurements were used to compare LN distances in individual patients to the spatial proximity of nodal metastases at a cohort level.Results34.7% of patients had pelvic LNs outside NRG-consensus, of which perirectal was most common (25.3% of all patients) followed by left common iliac nodes near the left psoas major (6.7%). A substantial portion of patients (13.3%) had nodes at the posterior edge of the NRG obturator level. Observer-independent mapping consistently visualized high-probability hotspots outside NRG-consensus in the perirectal and left common iliac regions. Affected nodes in individual patients occurred in highly significantly closer proximity than at cohort-level (mean distance, 6.6 cm vs. 8.7 cm, p < 0.001).ConclusionsBased on this analysis, the common iliac level should extend to the left psoas major and obturator levels should extend posteriorly 5 mm beyond the obturator internus. Incomplete coverage by the NRG-consensus was mostly because of perirectal involvement. We introduce three-dimensional kernel density estimation after non-rigid registration-based mapping for the analysis of recurrence data in radiotherapy. This technique provides an estimate of the underlying probability distribution of nodal involvement and may help in addressing institution- or subgroup-specific differences. Nodal metastases in individual patients occurred in highly significantly closer proximity than at a cohort-level, which supports that personalized target volumes could be reduced in size compared to a “one-size-fits-all” approach and is an important basis for further investigation into individualized field designs.

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Section: Methodsmentioning

confidence: 99%

The Distribution of Pelvic Nodal Metastases in Prostate Cancer Reveals Potential to Advance and Personalize Pelvic Radiotherapy

et al. 2021

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“…Since it is widely accepted that hormone-sensitive prostate cancer (HSPC) and castration-resistant prostate cancer (CRPC) are different entities in terms of tumor biology and prognosis, it is consequential that in most studies the status of hormone sensitivity was reported [7,12,13,17,19,22,30,32,34,35,44,49,50,53,54,58,[61][62][63][64][65]. In the study of Franzese et al CRPC was an independent risk factor for inferior PFS compared to HSPC in multivariate analysis (HR 2.12, p = 0.021) [19].…”

Section: Systemic Therapiesmentioning

confidence: 99%

“…In the trials using SBRT for MDT, recurrences occurred mostly in the same organ system, in lymph nodes or bone, respectively [15,17,44]. Moreover, Nicosia et al described that the majority of patients with nodal recurrence after SBRT suffered a lymph node relapse, which was out of but close to the radiation fields [53]. Soldatov et al reported a shift from iliac lymph node metastases to retroperitoneal lymph node metastases or from retroperitoneal to distant lymph node metastases and bone metastases in patients with oligometastatic lymph nodes treated with ENRT [54].…”

Section: Pattern Of Progressionmentioning

confidence: 99%

Radiotherapy of oligometastatic prostate cancer: a systematic review

et al. 2021

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Background Due to improved imaging sensitivity, the term “oligometastatic” prostate cancer disease is diagnosed more often, leading to an increasing interest in metastasis-directed therapy (MDT). There are two types of radiation based MDT applied when treating oligometastatic disease: (1) stereotactic body radiation therapy (SBRT) generally used for bone metastases; or (2) SBRT for isolated nodal oligometastases combined with prophylactic elective nodal radiotherapy. This review aims to summarize current evidence data, which may shed light on the optimal management of this heterogeneous group of patients. Methods A systematic review of the Medline database through PubMed was performed according to PRISMA guidelines. All relevant studies published up to November 2020 were identified and screened. Fifty-six titles were included. Besides outcome parameters, different prognostic and predictive factors were assessed, including site of metastases, time between primary treatment and MDT, use of systemic therapies, hormone sensitivity, as well as pattern of recurrence. Findings Evidence consists largely of retrospective case series and no consistent precise definition of oligometastasis exists, however, most investigators seem to acknowledge the need to distinguish between patients presenting with what is frequently called “synchronous” versus “metachronous” oligometastatic disease. Available data on radiotherapy as MDT demonstrate high local control rates and a small but relevant proportion of patients without progressive disease after 2 years. This holds true for both hormone sensitive and castration resistant prostate cancer diseases. The use of 68Ga-PSMA PET/CT for staging increased dramatically. Radiation doses and field sizes varied considerably among the studies. The search for relevant prognostic and predictive factors is ongoing. Conclusions To our best knowledge this review on oligometastatic prostate cancer included the largest number of original articles. It demonstrates the therapeutic potential and challenges of MDT for oligometastatic prostate cancer. Prospective studies are under way and will provide further high-level evidence.

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“…literature studies have supported the beneficial impact of the so-called metastasisdirected therapies (MDT) as a means to gain an advantage in terms of clinical outcomes [1,2]. Specifically for oligometastatic prostate cancer, the administration of stereotactic body radiotherapy (SBRT) has been favorably reported as a safe and effective tool, not only in terms of direct local control, but also as an option to delay the natural history of the disease by postponing the start of systemic therapies [3][4][5][6].…”

mentioning

confidence: 99%

Metastasis Directed Therapy and/or Systemic Therapy in Hormone-naive Oligometastatic Prostate Cancer Patient: an Emerging Dilemma

Cuccia

Alongi

2021

JMRO

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"The hormone-naive oligometastatic prostate cancer is a challenging setting for the radiation oncology community, as it represents a sort of transition scenario potentially suitable for two different approaches: a local ablative treatment alone vs a metastasisdirected treatment with the addition of hormone therapy. The choice to add androgen deprivation therapy in the oligorecurrent hormone-sensitive patient is a matter of debate, given the detrimental impact on quality of life and the number of adverse events. To date, there is no clear agreement on the optimal management of this subset of patients. As some authors highlight the attractiveness of a local approach alone, as well tolerated, easily repeatible and with very limited costs, on the other hand, other authors focus the need to cover the micrometastatic disease, often not detectable, even with the newly available imaging modalities. In this commentary, we briefly summarize the literature data in support of both therapeutic strategies."

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Recurrence pattern of stereotactic body radiotherapy in oligometastatic prostate cancer: a multi-institutional analysis

Cited by 32 publications

References 24 publications

The Distribution of Pelvic Nodal Metastases in Prostate Cancer Reveals Potential to Advance and Personalize Pelvic Radiotherapy

The Distribution of Pelvic Nodal Metastases in Prostate Cancer Reveals Potential to Advance and Personalize Pelvic Radiotherapy

Radiotherapy of oligometastatic prostate cancer: a systematic review

Metastasis Directed Therapy and/or Systemic Therapy in Hormone-naive Oligometastatic Prostate Cancer Patient: an Emerging Dilemma

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