Is there a favorable subset of patients with prostate cancer who develop oligometastases?

Singh, Deepinder; Yi, Won Sam; Brasacchio, Ralph; Muhs, A.; Smudzin, T.; Williams, Jacqueline P.; Messing, Edward M.; Okunieff, Paul

doi:10.1016/s0360-3016(03)01442-1

Cited by 212 publications

(161 citation statements)

References 19 publications

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“…26,27 Patients specifically with spine oligometastatic disease may have a more favorable survival compared with patients with synchronous metastatic disease in other sites, and are thus likely to benefit from an ablative rather than a palliative dose of radiation. Moreover, definitive treatment of oligometastatic disease may delay the initiation of or change in systemic therapy.…”

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confidence: 99%

The use of spine stereotactic radiosurgery for oligometastatic disease

Tang

Deegan

et al. 2016

SPI

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OBJECTIVE The authors investigated the outcomes following spine stereotactic radiosurgery (SSRS) for patients with oligometastatic disease of the spine. METHODS The study was a secondary analysis of 38 of 209 patients enrolled in 2 separate institutional Phase I/II prospective protocols and treated with SSRS between 2002 and 2011. Of these 38 patients, 33 (87%) were treated for a solitary spine metastasis, with no other history of metastatic disease. SSRS was prescribed to 24 Gy in 1 fraction (8%), 18 Gy in 1 fraction (18%), 16 Gy in 1 fraction (11%), 27 Gy in 3 fractions (53%), 30 Gy in 5 fractions (8%), or 20 Gy in 5 fractions (3%). Seventeen patients (45%) received prior conventional external beam radiation therapy. RESULTS The median overall survival (OS) was 75.7 months, and the 2- and 5-year OS rates were 84% and 60%, respectively. In multivariate analysis, patients who had prior spine surgery and a better Karnofsky Performance Scale score had an improved OS (HR 0.16, 95% CI 0.05–0.52, p < 0.01, and HR 0.33, 95% CI 0.13%–0.84%, p = 0.02, respectively), and those who had undergone prior radiation therapy had a worse OS (HR 3.6, 95% CI 1.2%–10%, p = 0.02). The 1-, 2-, and 5-year local progression-free survival rates were 85%, 82%, and 78%, respectively. The median time to systemic therapy modification was 41 months. Two patients (5%) experienced late Grade 3–4 toxicity. CONCLUSIONS Patients with oligometastatic disease of the spine treated with SSRS can experience long-term survival and a long time before needing a modification in systemic therapy. In addition, SSRS leads to excellent local control and minimal late toxicity.

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confidence: 99%

The use of spine stereotactic radiosurgery for oligometastatic disease

Tang

Deegan

et al. 2016

SPI

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“…In two other retrospective series of stage D prostate cancer, only 1 patient had clinically apparent lung metastasis without concurrent bony or lymph metastases. 10,28 Thus, the finding of an apparently solitary pulmonary metastasis from prostate cancer, with an otherwise negative metastatic workup is unusual and presents a therapeutic question of the role of metastasectomy. Our literature review provides some evidence that in a specific subset of patients with a low burden of metastases, even if it is usually regarded as a manifestation of systemic disease, surgery (especially minimally invasive surgery lobectomy or metastasectomy) may be an option.…”

Section: Discussionmentioning

confidence: 99%

The role of resection of pulmonary metastases from prostate cancer: a case report and literature review

Wallis

English

Goldenberg

2013

CUAJ

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We report a case of a 53-year-old man who presented with twonodules in the lower lobe and one nodule in the upper lobe of theright lung almost 7 years after radical prostatectomy for pT3aN0M0,Gleason 4+5 disease, without evidence of osseous or lymphaticspread. Surgical resection of the lower lung nodules confirmedmetastases, but prostate-specific antigen did not drop to undetectablelevels. Isolated pulmonary metastases from prostate cancerare rare with only 33 previously described cases in the Englishlanguageliterature, 18 of which were solitary metastases. Wereview the principles of management, including metastasectomyand long-term prognosis.

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“…Additionally, the standard treatment with ADT was recently challenged by the observation that a subset of PC patients develop metastases in limited numbers (termed oligometastases) and that survival and response to ADT varies as a function of the number of metastases. [56][57][58][59] It is hypothesized that local treatment of limited metastases, with surgery or radiotherapy, might delay the start of potentially toxic systemic treatments. 59 Moreover, patients with an initial low-volume metastatic disease were more likely to progress locally during ADT instead of distant, while the opposite was true for patients with highvolume metastatic disease.…”

Section: Radiotherapeutic Treatment Of Oligometastatic Pcmentioning

confidence: 99%

“…[56][57][58][59] It is hypothesized that local treatment of limited metastases, with surgery or radiotherapy, might delay the start of potentially toxic systemic treatments. 59 Moreover, patients with an initial low-volume metastatic disease were more likely to progress locally during ADT instead of distant, while the opposite was true for patients with highvolume metastatic disease. 56 However, traditional imaging studies (bone scan, CT and MRI) lack sufficient sensitivity to detect low volume metastatic disease at low PSA levels.…”

Section: Radiotherapeutic Treatment Of Oligometastatic Pcmentioning

confidence: 99%