EP-1346: Oligorecurrent nodal prostate cancer: long-term results of an elective nodal irradiation approach

Tran, Sébastien; Jorcano, S.; Falco, Teresa; Lamanna, Giorgio; Miralbell, Raymond; Zilli, Thomas

doi:10.1016/s0167-8140(17)31781-4

Cited by 7 publications

(13 citation statements)

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“…PFS rates at 3 years range between 49 and 75% (23). In one study by Tran et al a 5-year bRFS rate of 43% after elective nodal RT was reported (24). The only prospective trial is the oligo-pelvis-GETUG P07 trial (24).…”

Section: Discussionmentioning

confidence: 99%

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Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

et al. 2021

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BackgroundIn case of oligo-recurrent prostate cancer (PC) following prostatectomy, 68Ga-PSMA-PET/CT can be used to detect a specific site of recurrence and to initiate metastasis-directed radiation therapy (MDT). However, large heterogeneities exist concerning doses, treatment fields and radiation techniques, with some studies reporting focal radiotherapy (RT) to PSMA-PET/CT positive lesions only and other studies using elective RT strategies. We aimed to compare oncological outcomes and toxicity between PET/CT-directed RT (PDRT) and PDRT plus elective RT (eRT; i.e. prostate bed, pelvic or paraaortal nodes) in a large retrospective multicenter study.MethodsData of 394 patients with oligo-recurrent 68Ga-PSMA-PET/CT-positive PC treated between 04/2013 and 01/2018 in six different academic institutions were evaluated. Primary endpoint was biochemical-recurrence-free survival (bRFS). bRFS was analyzed using Kaplan–Meier survival curves and log rank testing. Uni- and multivariate analyses were performed to determine influence of treatment parameters.ResultsIn 204 patients (51.8%) RT was directed only to lesions seen on 68Ga-PSMA-PET/CT (PDRT), 190 patients (48.2%) received PDRT plus eRT. PDRT plus eRT was associated with a significantly improved 3-year bRFS compared to PDRT alone (53 vs. 37%; p = 0.001) and remained an independent factor in multivariate analysis (p = 0.006, HR 0.29, 95% CI 0.12–0.68). This effect was more pronounced in the subgroup of patients who were treated with PDRT and elective prostate bed radiotherapy (ePBRT) with a 3-year bRFS of 61% versus 22% (p <0.001). Acute and late toxicity grade ≥3 was 0.8% and 3% after PDRT plus eRT versus no toxicity grade ≥3 after PDRT alone.ConclusionsIn this large cohort of patients with oligo-recurrent prostate cancer, elective irradiation of the pelvic lymphatics and the prostatic bed significantly improved bRFS when added to 68Ga-PSMA-PET/CT-guided focal radiotherapy. These findings need to be evaluated in a randomized controlled trial.

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Section: Discussionmentioning

confidence: 99%

“…In one study by Tran et al a 5-year bRFS rate of 43% after elective nodal RT was reported (24). The only prospective trial is the oligo-pelvis-GETUG P07 trial (24). Early toxicity results have been published last year showing low grade 3 toxicity rates even though half of the patients had a re-irradiation of the pelvis (25).…”

Section: Discussionmentioning

confidence: 99%

Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

et al. 2021

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“…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.…”

Section: Defining Oligometastases: Clinical and Biologic Factorsmentioning

confidence: 99%

“…Most commonly, patients with oligorecurrence or de novo oligometastatic disease have been identified using a specific cutoff for the number of distant sites involved. A list of previously published literature with associated oligometastatic definitions is displayed in Table , with similar definitions used by ongoing, prospective investigations listed in Table . Of 25 retrospective reviews that included >1 case, 10 (40%) used a definition of ≤5 metastases, 3 (12%) used a definition of ≤4 metastases, and 12 (48%) used a definition of ≤3 metastases to define patients with oligometastases in the recurrent or de novo setting.…”

Section: Defining Oligometastases: Clinical and Biologic Factorsmentioning

confidence: 99%

Oligometastatic prostate cancer: Reality or figment of imagination?

Foster

Weichselbaum

Pitroda

2018

Cancer

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The term “oligometastatic prostate cancer” refers to a heterogeneous group of disease states currently defined solely on the basis of clinical features. Oligorecurrent disease, de novo oligometastases, and oligoprogressive disease likely have unique biologic underpinnings and natural histories. Evidence suggesting the existence of a subset of patients who harbor prostate cancer with limited metastatic potential currently includes disparate and overwhelmingly retrospective reports. Nevertheless, emerging prospective data have corroborated the “better‐than‐expected,” retrospectively observed outcomes, particularly in the setting of oligorecurrent prostate cancer. Improved functional imaging with prostate‐specific membrane antigen‐targeted strategies may enhance the identification of patients with oligometastatic prostate cancer in the short term. In the long term, refinement of the oligometastatic case definition likely will require biologic risk‐stratification schemes. To determine optimal treatment strategies and identify patients most likely to benefit from metastasis‐directed therapy, future efforts should focus on conducting high‐quality, prospective trials with much‐needed molecular correlative studies.

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“…These comparable results could probably be explained by a lack of sufficient sensitivity of the current imaging techniques to perform a lesion-based approach, either by SBRT or sLND. An elective nodal irradiation approach using whole pelvic radiotherapy (WPRT) in addition to MDT could delay or even prevent such relapse [12,[15][16][17]. Improved progressionfree survival (PFS) rates have been observed with WPRT in radiotherapy series [15][16][17], as well as after sLND as demonstrated in the retrospective study by Rischke et al [12].…”

Section: Introductionmentioning

confidence: 99%

PEACE V – Salvage Treatment of OligoRecurrent nodal prostate cancer Metastases (STORM): a study protocol for a randomized controlled phase II trial

et al. 2020

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Background: Pelvic nodal recurrences are being increasingly diagnosed with the introduction of new molecular imaging techniques, like choline and PSMA PET-CT, in the restaging of recurrent prostate cancer (PCa). At this moment, there are no specific treatment recommendations for patients with limited nodal recurrences and different locoregional treatment approaches are currently being used, mostly by means of metastasis-directed therapies (MDT): salvage lymph node dissection (sLND) or stereotactic body radiotherapy (SBRT). Since the majority of patients treated with MDT relapse within 2 years in adjacent lymph node regions, with an estimated median time to progression of 12-18 months, combining MDT with whole pelvic radiotherapy (WPRT) may improve oncological outcomes in these patients. The aim of this prospective multicentre randomized controlled phase II trial is to assess the impact of the addition of WPRT to MDT and short-term androgen deprivation therapy (ADT) on metastasis-free survival (MFS) in the setting of oligorecurrent pelvic nodal recurrence. Methods & design: Patients diagnosed with PET-detected pelvic nodal oligorecurrence (≤5 nodes) following radical local treatment for PCa, will be randomized in a 1:1 ratio between arm A: MDT and 6 months of ADT, or arm B: WPRT added to MDT and 6 months of ADT. Patients will be stratified by type of PET-tracer (choline, FACBC or PSMA) and by type of MDT (sLND or SBRT). The primary endpoint is MFS and the secondary endpoints include clinical and biochemical progression-free survival (PFS), prostate cancer specific survival, quality of life (QoL), toxicity and time to castration-resistant prostate cancer (CRPC) and to palliative ADT. Estimated study completion: December 31, 2023.

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EP-1346: Oligorecurrent nodal prostate cancer: long-term results of an elective nodal irradiation approach

Cited by 7 publications

References 0 publications

Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

Oligometastatic prostate cancer: Reality or figment of imagination?

PEACE V – Salvage Treatment of OligoRecurrent nodal prostate cancer Metastases (STORM): a study protocol for a randomized controlled phase II trial

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