The efficacy of stereotactic body radiation therapy and the impact of systemic treatments in oligometastatic patients from prostate cancer

Abstract

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

“…Franzese et al 7 report worse progression-free survival following SBRT for castration-resistant patients compared to castrationsensitive patients, however, no statistically significant difference was observed between these groups in our study in terms of treatment escalation. This may be because the number of castrationresistant men in our study was too low to detect a difference.…”

“…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.…”

Oligometastatic prostate cancer: Reality or figment of imagination?

“…Therefore, potential treatment strategies for de novo oligometastases must consider the management of an intact primary tumor in addition to distant lesions. A third state known as oligoprogression also is emerging and identifies patients who have widespread metastases with only limited sites of progression on systemic therapy . Notably, patients with oligoprogressive disease have been poorly represented in retrospective studies, although series that included mixed histologies, and prostate cancer specifically, have suggested a worse prognosis compared with those who have traditional oligometastasis.…”

“…7 Ongoing prospective studies have taken similarly disparate approaches to defining oligometastasis with 12 of 20 (60%), 3 of 20 (15%), and 5 of 20 (25%) with available information using cutoffs of ≤5, ≤4, and ≤3 metastases for inclusion, respectively. Additional stipulations have focused on sites of involvement, including lesions in only 1 or 2 organs, 15,71 exclusive lymph node involvement, [19][20][21][22][23]28,30,39,40,45,70 or the exclusion of intracranial disease. 7,69,71 Whether prostatic oligometastases are defined optimally by the number and/or location of lesions and which number and locations are most suitable to select for patients with limited metastatic potential have yet to be determined.…”