Stereotactic body radiotherapy for oligoprogressive lesions in metastatic castration‐resistant prostate cancer patients during abiraterone/enzalutamide treatment

Onal, Cem; Köse, Fatih; Özyiğit, Gökhan; Aksoy, Sercan; Oymak, Ezgi; Muallaoğlu, Sadık; Güler, Ozan Cem; Tilki, Burak; Hürmüz, Pervin; Akyol, Fadıl

doi:10.1002/pros.24132

Cited by 24 publications

(20 citation statements)

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“… Kaplan-Meier plots of survival outcomes ( 9 ). ADT, androgen deprivation therapy; BPFS, biochemical progression-free survival; CRPC, castrate-resistant prostate cancer; DMFS, distant metastasis-free survival; HSPC, hormone-sensitive prostate cancer; OS, overall survival; SABR, stereotactic ablative radiotherapy.…”

Section: Resultsmentioning

confidence: 99%

Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

et al. 2022

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IntroductionThe addition of stereotactic ablative radiotherapy (SABR) to standard of care for patients with oligometastatic prostate cancer has the potential of improving survival and delaying further metastases. The primary aim of this analysis is to report survival outcomes and pattern of recurrence of patients with hormone-sensitive (HSPC) and castrate-resistant (CRPC) oligometastatic prostate cancer treated with SABR.MethodsThis is a single-center retrospective study of patients with oligometastatic prostate cancer treated in Iridium Network between 2014 and 2018. All patients with oligometastatic (≤3 active lesions) HSPC and CRPC treated with SABR were included. Data were collected using electronic records. Patterns of first progression following SABR were reported. Kaplan-Meier methods were used to determine survival outcomes.ResultsEighty-seven men received SABR to 115 metastases. Nineteen patients were castrate-resistant and 68 hormone-sensitive at the time of SABR. Median follow-up was 41.6 months. In 25% of patients, no decline from baseline PSA was recorded. Median bPFS was 11.7 months (95% CI 7.6 - 18.3) for HSPC as well as CRPC (95% CI 6.4 - 24.0) (p=0.27). Median DMFS was 21.8 (95% CI 16.9 - 43.2) versus 17.6 months (95% CI 6.7 - 26.2) for HSPC versus CRPC, respectively (p=0.018). Median OS was 72.6 months (95% CI 72.6 – not reached) for HSPC and not reached for CRPC (95% CI 35.4 months – not reached) (p=0.026). For the subgroup of oligorecurrent HSPC, short-term androgen-deprivation therapy was associated with improved bPFS (median 6.0 vs. 18.3 months, HR 0.31, p<0.001) and DMFS (median 15.8 vs 29.6 months, HR 0.5, p=0.06). Information on pattern of relapse was retrieved for 79 patients: 45% (36/79) of these patients were long-term disease-free (>18 months), 28% (22/79) of patients wmere oligoprogressive (≤3 new lesions) and 27% (21/79) developed a polymetastatic relapse.ConclusionIn this cohort, oligometastatic HSPC showed potential benefit from SABR with a median DMFS of 21.8 months. Well-selected patients with oligometastatic CRPC may also benefit from SABR. For patients with metachronous and repeat oligorecurrent HSPC, combining SABR with short-term androgen-deprivation therapy was associated with improved bPFS and DMFS. Overall, 36/87 (41%) of patients were still free from clinical relapse at 18 months.

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Section: Resultsmentioning

confidence: 99%

Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

et al. 2022

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“…One of the latest experience about SBRT was made by Onal and colleagues in Turkey (37). They treated 126 oligoprogressive lesions in 54 metastatic castration-resistant prostate cancer patients during therapy with abiraterone or enzalutamide, before or after systemic chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…With the advent of systemic therapy options that have led to prolonged survival compared to historical standards, even in men with widespread metastatic disease, there has been growing interest in the use of radiotherapy for OPD, with the rationale being that treating sites of oligoprogression may allow patients to remain on the same agent for a longer duration by eradicating tumor clones that have developed resistance to the agent ( 11 ). However, no large prospective study exists on the clinical utility of radiotherapy in the setting of OPD, although a prospective trial is currently accruing ( Table 2 ).…”

Section: Radiotherapy In (Opd) Oligoprogressive Diseasementioning

confidence: 99%

“…Of note, the number of oligoprogressive lesions requiring treatment and the time between start of abiraterone or enzalutamide and RT treatment were prognostic factors for PCSS on univariate analysis, although the number of lesions treated was only borderline significant on multivariate analysis (p=0.06). Further supporting the use of RT to delay a change in systemic therapy, SBRT to oligoprogressive lesions allowed for continuation of the patients’ current systemic therapies for a median of 8.6 months ( 11 ). A second retrospective study by Onal et al.…”

Section: Radiotherapy In (Opd) Oligoprogressive Diseasementioning

confidence: 99%

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Radiotherapy in Oligometastatic, Oligorecurrent and Oligoprogressive Prostate Cancer: A Mini-Review

et al. 2022

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Globally, prostate cancer is one of the most common malignancies affecting men. With the advent of advanced molecular imaging, an increasing number of men are found to have oligometastatic disease (OD) either at primary diagnosis or at the time of biochemical failure. No strict definition exists for OD, with historical and ongoing studies utilizing diverse criteria. There is mounting evidence from many different malignancies that patients with OD have improved outcomes compared to their widely metastatic counterparts. As such, treatment intensification of those with OD or oligoprogressive disease has become an area of intense interest and study. This article will review the biology, evidence and controversy behind the treatment of de novo oligometastatic, oligorecurrent and oligoprogressive prostate cancer.

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Stereotactic body radiotherapy for oligoprogressive lesions in metastatic castration‐resistant prostate cancer patients during abiraterone/enzalutamide treatment

Cited by 24 publications

References 43 publications

Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

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

Radiotherapy in Oligometastatic, Oligorecurrent and Oligoprogressive Prostate Cancer: A Mini-Review

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