Utilization of stereotactic ablative radiotherapy in oligometastatic &amp; oligoprogressive skeletal metastases: Results and pattern of failure

Kam, Tsz Yeung; Chan, Oscar S.H.; Hung, Albert W M; Yeung, Richie

doi:10.1111/ajco.13115

Cited by 12 publications

(9 citation statements)

References 20 publications

(22 reference statements)

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“…Those data correspond to the findings of Triggiani et al [123]. Others have investigated oligoprogression both in CSPC and CRPC patients [124][125][126][127][128][129][130], with only limited information available on the CRPC patients. A case report demonstrated the potential of SBRT as an additional tool in long-term control of oligoprogressive disease in CRPC, while the systemic therapy could be preserved [131].…”

Section: Oligoprogression In Castration-refractory Prostate Cancersupporting

confidence: 89%

Metastasis-directed therapy for oligometastatic urological tumours: still no second-hand news

Berghen¹,

Joniau²,

Vulsteke³

et al. 2020

ecancer

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For patients presenting with limited metastatic disease burden, known as the oligometastatic state of disease, a more aggressive treatment approach targeting the new or progressive metastatic lesions might improve patient outcome, with no or only limited toxicity to be expected from the treatment. This review provides an overview of the existing evidence and on-going trials on oligometastatic disease and metastasis-directed therapy in the field of renal, bladder and prostate cancer.

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Section: Oligoprogression In Castration-refractory Prostate Cancersupporting

confidence: 89%

Metastasis-directed therapy for oligometastatic urological tumours: still no second-hand news

Berghen¹,

Joniau²,

Vulsteke³

et al. 2020

ecancer

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“…Preliminary data, mainly from retrospective studies suggested that progression-directed therapy (PDT) to these oligoprogressive lesions allows patients to remain on their current systemic therapy, thereby delaying the need for NEST. Preliminary data support this hypothesis [8][9][10][11][12][13][14][15][16][17][18][19]. Our research group recently published promising results on the use of PDT in this setting, with a next-line systemic treatment-free survival (NEST-FS) of 21 months [20].…”

Section: Introductionmentioning

confidence: 87%

Metastasis-directed therapy in castration-refractory prostate cancer (MEDCARE): a non-randomized phase 2 trial

et al. 2020

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Background: Patients diagnosed with metastatic castration-refractory prostate cancer (mCRPC) rely on a limited number of therapeutic agents resulting in a median survival of 2-3 years. A subgroup of those patients with mCRPC presents with oligoprogressive disease, with a limited number of progressive lesions while other metastases are still controlled by ongoing systemic treatment. Methods: In this single arm prospective phase II trial, we aim to include 18 patients with oligoprogressive mCRPC (1-3 metastases and/or local recurrence) who will be treated with metastasis-directed therapy to all visible progressive lesions. Progression is based on conventional imaging, as the use of PSMA PET-CT is considered investigational. However all patients will undergo PSMA PET-CT and the images will be blinded until progression. Primary endpoint is the postponement of the start of next-line systemic treatment (NEST) and the additional clinical value of PSMA PET-CT. Recruitment of patients for this trial started in January 2020 and will be completed approximately by December 2020. Discussion: In this phase 2 trial on oligoprogressive mCRPC, we will investigate the benefit of progression-directed therapy while continuing ongoing systemic treatment. We hypothesize that progression-directed therapy (PDT) with surgery or stereotactic body radiation therapy for these oligoprogressive lesions will postpone the start of next-line systemic treatment and therefore serve as a new or add-on therapy in the spectrum of treatments available for mCRPC. The results of this trial will serve as guidance for a later randomized phase 3 trial. All participants are given an information sheet and are required to give written informed consent. Results will be published in a peer-reviewed journal. Trial registration: This study is registered at ClinicalTrials.gov: NCT04222634 (December 18th 2019).

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“…Some studies included comparison with polymetastatic disease of spine and compared outcomes, this was excluded when analyzing Kaplan Meier Curves or data tables. Only statistically significant data was chosen to make valid comparisons between Local Control or Overall Survival rates [7][8][9][10][11][12][13][14][15][16][17][18] .…”

Section: Methodsmentioning

confidence: 99%

Comparison of the Effectiveness of Stereotactic Radiosurgery for Spinal Oligometastatic Disease With Surgical and Conventional External Beam Radiotherapy Determined by Local Control, Overall Survival, Pain Response and Toxicities: A Systematic Review.

Saha¹,

Hamdan²,

Ajayi³

et al. 2020

BJSRG

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The aim of this study is to determine whether there is a benefit of using stereotactic radiosurgery (SRS) versus surgery or conventional external beam radiotherapy (cEBRT) for spinal oligometastatic disease in terms of tumor control, pain control, toxicity and morbidity. This systematic review was conducted by searching electronic databases such as Pubmed, Medline (Ovid) and Oxford Academic using an adapted version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) checklist. Retrospective and prospective studies were identified and investigated for methods of treatment such as SRS, surgery and radiotherapy of spinal oligometastatic disease. Local Control rates, Overall Survival (OS) rates, Pain Response (PR) and toxicities were extracted to be investigated and compared. A study eligibility criterion was made to ensure that results were valid, statistically significant and relevant to the investigation. One hundred and five articles were relevant to oligometastatic disease with the mention of spinal metastases however 89 of these articles were excluded based on irrelevance to investigation, title, abstract and duplication. Sixteen full text articles were thoroughly screened including 9 of them in the review. For 601 patients the average one year local control rate was 89%, average one year overall survival rate was 88%, evidence of pain relief was present, and some patients suffered low grade toxicities. In conclusion, stereotactic radiosurgery is an excellent modality of treatment of spinal oligometastatic disease as local control rates, overall survival rates, pain response and toxicities indicate improved outcomes in comparison to studies that investigated the same factors with the treatment of surgery or cEBRT. However, there is a lack of data here to make statistically valid claims and require more studies & data to be analyzed and compared.

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Utilization of stereotactic ablative radiotherapy in oligometastatic & oligoprogressive skeletal metastases: Results and pattern of failure

Cited by 12 publications

References 20 publications

Metastasis-directed therapy for oligometastatic urological tumours: still no second-hand news

Metastasis-directed therapy for oligometastatic urological tumours: still no second-hand news

Metastasis-directed therapy in castration-refractory prostate cancer (MEDCARE): a non-randomized phase 2 trial

Comparison of the Effectiveness of Stereotactic Radiosurgery for Spinal Oligometastatic Disease With Surgical and Conventional External Beam Radiotherapy Determined by Local Control, Overall Survival, Pain Response and Toxicities: A Systematic Review.

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