Oligometastases from prostate cancer: local treatment with stereotactic body radiotherapy (SBRT)

BMC Cancer

Research Article

Markus Schwaiger¹  Matthias Eiber¹  Marciana Nona Duma²  Gregor Habl²  Kilian Schiller²  Christoph Straube²  Markus Oechsner²  Kerstin A. Kessel³  Stephanie E. Combs³  Jürgen E. Gschwend⁴  Hubert Kübler⁵ 

[1] Department of Nuclear Medicine, Technical University Munich (TUM), Munich, Germany;Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany;Zentrum für Stereotaxie und personalisierte Hochpräzisionsstrahlentherapie (StereotakTUM), Technische Universität München (TUM), Munich, Germany;Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675, Munich, Germany;Zentrum für Stereotaxie und personalisierte Hochpräzisionsstrahlentherapie (StereotakTUM), Technische Universität München (TUM), Munich, Germany;Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany;Department of Urology, Technical University Munich (TUM), Munich, Germany;Department of Urology, Technical University Munich (TUM), Munich, Germany;Department of Urology, University of Würzburg, Würzburg, Germany;

关键词: Prostate cancer;    Oligometastases;    Individualized radiotherapy;    SBRT;    PSMA-PET;    PSA;   

DOI  :  10.1186/s12885-017-3341-2

 received in 2016-10-27, accepted in 2017-05-11,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe impact of local tumor ablative therapy in oligometastasized prostate cancer (PC) is still under debate. To gain data for this approach, we evaluated oligometastasized PC patients receiving stereotactic body radiotherapy (SBRT) to bone metastases.MethodsIn this retrospective study, 15 oligometastasized PC patients with a total of 20 bone metastases were evaluated regarding biochemical progression-free survival (PSA-PFS), time to initiation of ADT, and local control rate (LCR). Three patients received concomitant androgen deprivation therapy (ADT).ResultsThe median follow-up after RT was 22.5 months (range 7.0–53.7 months). The median PSA-PFS was 6.9 months (range 1.1–28.4 months). All patients showing a decrease of PSA level after RT of at least factor 10 reveal a PSA-PFS of >12 months. Median PSA-PFS of this sub-group was 23.1 months (range 12.1–28.4 months). Local PFS (LPFS) after 2 years was 100%. One patient developed a local failure after 28.4 months. Median distant PFS (DPFS) was 7.36 months (range 1.74–54.34 months). The time to initiation of ADT in patients treated without ADT was 9.3 months (range 2.6–36.1 months). In all patients, the time to intensification of systemic therapy or the time to initiation of ADT increased from 9.3 to 12.3 months (range 2.6–36.1 months). Gleason-Score, ADT or the localization of metastasis had no impact on PFS or time to intensification of systemic therapy. No SBRT related acute or late toxicities were observed.ConclusionOur study shows that SBRT of bone metastases is a highly effective therapy with an excellent risk-benefit profile. However, PFS was limited due to a high distant failure rate implying the difficulty for patient selection for this oligometastatic concept. SBRT offers high local cancer control rates in bone oligometastases of PC and should be evaluated with the aim of curation or to delay modification of systemic treatment.

【 授权许可】

CC BY   
© The Author(s). 2017