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Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence.

Decaestecker K, De Meerleer G, Lambert B, Delrue L, Fonteyne V, Claeys T, De Vos F, Huysse W, Hautekiet A, Maes G, Ost P - Radiat Oncol (2014)

Bottom Line: This results in a median ADT-FS of 25 months (20-30 mo).On univariate analysis, only a short PSA doubling time was a significant predictor for both PFS (HR: 0.90, 95% CI: 0.82 - 0.99) and ADT-FS (HR: 0.83; 95% CI: 0.71 - 0.97).Repeated SBRT for oligometastatic prostate cancer postpones palliative androgen deprivation therapy with 2 years without grade III toxicity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium. Piet.ost@ugent.be.

ABSTRACT

Purpose: To assess the outcome of prostate cancer (PCa) patients diagnosed with oligometastatic disease at recurrence and treated with stereotactic body radiotherapy (SBRT).

Methods: Non-castrate patients with up to 3 synchronous metastases (bone and/or lymph nodes) diagnosed on positron emission tomography - computed tomography, following biochemical recurrence after local curative treatment, were treated with (repeated) SBRT to a dose of 50 Gy in 10 fractions or 30 Gy in 3 fractions. Androgen deprivation therapy-free survival (ADT-FS) defined as the time interval between the first day of SBRT and the initiation of ADT was the primary endpoint. ADT was initiated if more than 3 metastases were detected during follow-up even when patients were still asymptomatic. Secondary endpoints were local control, progression free survival (PFS) and toxicity. Toxicity was scored using the Common Terminology Criteria for Adverse Events.

Results: With a median follow-up from time of SBRT of 2 years, we treated 50 patients with 70 metastatic lesions with a local control rate of 100%. The primary involved metastatic sites were lymph nodes (54%), bone (44%), and viscera (2%). The median PFS was 19 mo (95% CI: 13-25 mo) with 75% of recurring patients having ≤3 metastases. A 2nd and 3rd course of SBRT was delivered in 19 and 6 patients respectively. This results in a median ADT-FS of 25 months (20-30 mo). On univariate analysis, only a short PSA doubling time was a significant predictor for both PFS (HR: 0.90, 95% CI: 0.82 - 0.99) and ADT-FS (HR: 0.83; 95% CI: 0.71 - 0.97). Ten patients (20%) developed toxicity following treatment, which was classified as grade I in 7 and grade II in 3 patients.

Conclusion: Repeated SBRT for oligometastatic prostate cancer postpones palliative androgen deprivation therapy with 2 years without grade III toxicity.

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Schematic overview of relapse pattern of oligometastic prostate cancer recurrence following stereotactic body radiotherapy.
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Figure 1: Schematic overview of relapse pattern of oligometastic prostate cancer recurrence following stereotactic body radiotherapy.

Mentions: Patterns of first progression following SBRT were recorded and are displayed in Figure 1. After a median follow-up of 2 years (interquartile range, IQR: 8 – 52 mo), 18 patients were disease-free and 32 patients experienced distant metastatic progression, resulting in a median PFS of 19 mo (95% CI: 13–25 mo) (Figure 2a). The 1-year and 2-year PFS rates were 64% and 35% respectively. None of the patients had a local recurrence, resulting in a 100% local control rate. The median PSA at recurrence was 8.5 ng/ml (IQR: 2 – 32 ng/ml) with a median doubling time of 2.7 mo (IQR: 1.5 – 4.7 mo).For patients with initial pelvic lymph node metastases, 67% of the relapses were located in the pelvis or retroperitoneal nodes (Figure 3a) and 33% in the bone. For patients with initial bone metastases, the first site of recurrence following SBRT was located in the bone in 88% of the cases (Figure 3b). Initial progression was again limited to ≤3 metastases in 75% of recurrent patients (N = 24), of which 16 patients received a second course of SBRT and 3 patients received a salvage pelvic lymphadenectomy. The remaining 5 oligometastatic patients and 8 polymetastatic patients received palliative ADT. In the former, the patients refused a second course of SBRT.


Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence.

Decaestecker K, De Meerleer G, Lambert B, Delrue L, Fonteyne V, Claeys T, De Vos F, Huysse W, Hautekiet A, Maes G, Ost P - Radiat Oncol (2014)

Schematic overview of relapse pattern of oligometastic prostate cancer recurrence following stereotactic body radiotherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4066290&req=5

Figure 1: Schematic overview of relapse pattern of oligometastic prostate cancer recurrence following stereotactic body radiotherapy.
Mentions: Patterns of first progression following SBRT were recorded and are displayed in Figure 1. After a median follow-up of 2 years (interquartile range, IQR: 8 – 52 mo), 18 patients were disease-free and 32 patients experienced distant metastatic progression, resulting in a median PFS of 19 mo (95% CI: 13–25 mo) (Figure 2a). The 1-year and 2-year PFS rates were 64% and 35% respectively. None of the patients had a local recurrence, resulting in a 100% local control rate. The median PSA at recurrence was 8.5 ng/ml (IQR: 2 – 32 ng/ml) with a median doubling time of 2.7 mo (IQR: 1.5 – 4.7 mo).For patients with initial pelvic lymph node metastases, 67% of the relapses were located in the pelvis or retroperitoneal nodes (Figure 3a) and 33% in the bone. For patients with initial bone metastases, the first site of recurrence following SBRT was located in the bone in 88% of the cases (Figure 3b). Initial progression was again limited to ≤3 metastases in 75% of recurrent patients (N = 24), of which 16 patients received a second course of SBRT and 3 patients received a salvage pelvic lymphadenectomy. The remaining 5 oligometastatic patients and 8 polymetastatic patients received palliative ADT. In the former, the patients refused a second course of SBRT.

Bottom Line: This results in a median ADT-FS of 25 months (20-30 mo).On univariate analysis, only a short PSA doubling time was a significant predictor for both PFS (HR: 0.90, 95% CI: 0.82 - 0.99) and ADT-FS (HR: 0.83; 95% CI: 0.71 - 0.97).Repeated SBRT for oligometastatic prostate cancer postpones palliative androgen deprivation therapy with 2 years without grade III toxicity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium. Piet.ost@ugent.be.

ABSTRACT

Purpose: To assess the outcome of prostate cancer (PCa) patients diagnosed with oligometastatic disease at recurrence and treated with stereotactic body radiotherapy (SBRT).

Methods: Non-castrate patients with up to 3 synchronous metastases (bone and/or lymph nodes) diagnosed on positron emission tomography - computed tomography, following biochemical recurrence after local curative treatment, were treated with (repeated) SBRT to a dose of 50 Gy in 10 fractions or 30 Gy in 3 fractions. Androgen deprivation therapy-free survival (ADT-FS) defined as the time interval between the first day of SBRT and the initiation of ADT was the primary endpoint. ADT was initiated if more than 3 metastases were detected during follow-up even when patients were still asymptomatic. Secondary endpoints were local control, progression free survival (PFS) and toxicity. Toxicity was scored using the Common Terminology Criteria for Adverse Events.

Results: With a median follow-up from time of SBRT of 2 years, we treated 50 patients with 70 metastatic lesions with a local control rate of 100%. The primary involved metastatic sites were lymph nodes (54%), bone (44%), and viscera (2%). The median PFS was 19 mo (95% CI: 13-25 mo) with 75% of recurring patients having ≤3 metastases. A 2nd and 3rd course of SBRT was delivered in 19 and 6 patients respectively. This results in a median ADT-FS of 25 months (20-30 mo). On univariate analysis, only a short PSA doubling time was a significant predictor for both PFS (HR: 0.90, 95% CI: 0.82 - 0.99) and ADT-FS (HR: 0.83; 95% CI: 0.71 - 0.97). Ten patients (20%) developed toxicity following treatment, which was classified as grade I in 7 and grade II in 3 patients.

Conclusion: Repeated SBRT for oligometastatic prostate cancer postpones palliative androgen deprivation therapy with 2 years without grade III toxicity.

Show MeSH
Related in: MedlinePlus