Background: Several immunotherapy (IT) agents are FDA approved for treatment of melanoma and non-small-cell lung cancer (NSCLC). The addition of stereotactic radiosurgery (SRS) or stereotactic body radiation therapy (SBRT) to immunotherapy looks promising. A systematic review was conducted to evaluate the possible synergistic effects of immune checkpoints inhibitors (ICIs) and stereotactic radiation therapy in melanoma and NSCLC. Materials and methods: Pubmed databases from January 2010 to December 2020 were reviewed to identify English language studies reporting control of local and abscopal effect of the combination of ICI-SBRT/SRS in metastatic NSCLC and melanoma cancer. The inclusion criteria were followed according to PICO criteria. Results: Thirty-nine articles were included of the 2141 initial results. The reported rates for local control were 16.5–100% and 40–94% in brain and extracerebral metastases, respectively. Distant/abscopal response rates were 1–45% in extracerebral metastases. Abscopal effect could not be evaluated in brain metastases because it was not reported in studies. Treatments were well tolerated with few grade 4 toxicities and no grade 5. Conclusions: The combined treatment of ICI-SBRT/SRS achieves high local control and non-negligible abscopal response in patients with extracerebral metastases, with its benefit in cerebral metastases being more controversial. Clinical trials are needed to better characterize the potential synergism.

El cáncer de próstata es una causa común de muerte en hombres occidentales. La morbimortalidad asociada suele ser consecuencia directa de la diseminación ósea, presente en hasta un 50% de los pacientes en el momento del diagnóstico. El objetivo del tratamiento de estos enfermos metastá-sicos es la prevención o paliación de los síntomas y de las complicaciones. El arsenal terapéutico es amplio e incluye hormonoterapia, radioterapia externa, radiofármacos, cirugía, quimioterapia, bisfosfonatos y nuevos fármacos (inhibidores de la angiogénesis, inmunoterapia y fármacos que actú-an sobre la diferenciación celular). En la elección del tratamiento se deben considerar múltiples factores: la condición de andrógeno-dependiente o andrógeno-independiente, ya que la terapia hormonal constituye el primer escalón del tratamiento; la localización y extensión de la destrucción ósea; la gravedad del cuadro; la disponibilidad de las diferentes terapias; el estado del paciente; el pronóstico de supervivencia y la relación coste-efecto. Las indicaciones de algunas de estas terapias están claramente establecidas mientras que otras están todavía en estudio para determinar su eficacia, la pauta de tratamiento y las indicaciones. En este artículo se realiza una revisión y actualización de dichos tratamientos.PALABRAS CLAVE: Próstata. Metastásico. Hormonoterapia. Radioterapia. Quimioterapia. Bisfosfonatos. Radiofármacos. Cirugía.Nuevas terapias. ABSTRACTCURRENT MULTIAPPROACH TREATMENT OF METASTATIC PROSTATE CANCER Prostate cancer is one of the commonest causes of cancer-related death in the western world. The morbi-mortality associated is usually a direct consequence of metastatic spread to bone, in up to 50% of patients at first presentation. The aim of treatment of metastatic patients is to alleviate and to prevent the distressing symptoms. The approach include hormone-therapy, radiotherapy, radionuclides, surgery, chemotherapy, bisphosphonates and new drugs (agents that inhibit angiogenesis, inmmunotherapy and therapies that affect the differentiation). Decisions about therapy must also take into consideration the androgen-dependent or independent, so hormone-therapy is the first step of the treatment; the number and location of bone metastases; the severity of symptoms; the available of therapies; the status performance of patient; the prognosis and the cost-effect relationship. Some treatments have established indications whereas others are still in process of study in order to determinate their efficacy, their model of treatment and their indications. This article revises and updates these treatments.

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