Stereotactic body radiotherapy for castration-sensitive prostate cancer bone oligometastases

Abstract

To evaluate outcome in patients treated with stereotactic body radiotherapy (SBRT) on bone oligometastases from castration-sensitive prostate cancer after primary treatment. We retrospectively collected data of patients with less than five lesions at time of SBRT and hormone-naïve disease at the first extra-regional localization, treated between 03/2012 and 11/2016. Prostate-specific antigen (PSA) was measured every 3 months after SBRT. Imaging was performed in case of progression. Survival analysis was performed with Kaplan-Meier (log-rank test) approach. Fifty-five patients were treated on 77 bone oligometastases. Median age, initial PSA and pre-SBRT PSA were 72 years, 9.12 and 3.5 ng/mL, respectively. Twenty-five patients (45%) received SBRT alone while the remaining 30 patients (55%) received concomitant ADT. Median follow-up was 24.6 months (range 3.0-67.2 months). No acute or late toxicity of grade > 1 was reported. Clinical progression was observed in 38 (69%) patients. 1-year biochemical progression-free survival (b-PFS), clinical progression-free survival (c-PFS), prostate-specific survival (PCSS) and local control (LC) rates were 51, 56, 100 and 83%, respectively. Comparing patients treated with SBRT alone and with concomitant ADT, no significant differences were found for those outcomes. SBRT is safe and allows high 1-year LC rate (83%) with low toxicity profile. No significant improvement in outcomes was registered with the addition of ADT to SBRT.

Fractionated stereotactic body radiotherapy for up to five prostate cancer oligometastases: Interim outcomes of a prospective clinical trial

“…No grade three or higher toxicities were reported by Decaestecker et al . (50 Gy in 10 fractions, 30 Gy in 3 fractions), Fanetti et al . (4–15 Gy in 1–5 fractions) or Ost et al .…”

“…13 months for surveillance among men with up to three PCa oligometastases. In addition, several relatively small studies demonstrate the efficacy of metastasis‐directed radiotherapy to delay the clinical progression of oligometastatic PCa, with minimal adverse effects …”

“…In addition, several relatively small studies demonstrate the efficacy of metastasis-directed radiotherapy to delay the clinical progression of oligometastatic PCa, with minimal adverse effects. [5][6][7][8] Despite these promising results, the subset of patients who will benefit most from MDT has not yet been defined. 3 Studies powered by large sample sizes are still required to assess the influence of factors such as lesion number, lesion location and hormone sensitivity on the efficacy of MDT.…”

Prostate‐specific membrane antigen‐positron emission tomography/computed tomography (PSMA‐PET/CT)‐guided stereotactic ablative body radiotherapy for oligometastatic prostate cancer: a single‐institution experience and review of the published literature

“…While there has been a surge in publications on PSMA‐PET/CT and SABR for oligometastatic PCa , only a few studies have reported the outcomes of SABR for PSMA‐PET/CT‐defined oligometastatic PCa (Table ) .…”

“…The advent of prostate‐specific membrane antigen (PSMA)‐PET/CT has allowed better detection of oligometastatic lesions in men with PCa . While there is an earlier study reporting on PSMA‐PET/CT‐guided conventional fractionated radiotherapy for oligometastatic disease , to our knowledge, published studies on the outcomes of PSMA PET/CT‐guided SABR for oligometastatic PCa are lacking .…”