Pattern of Progression after Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Nodal Recurrences

Ost, Piet; Jereczek-Fossa, B.A.; As, N. van; Zilli, Thomas; Tree, A.; Henderson, D.; Orecchia, Roberto; Casamassima, F.; Surgo, A.; Miralbell, Raymond; Meerleer, Gert De

doi:10.1016/j.clon.2016.04.040

Cited by 106 publications

(84 citation statements)

References 22 publications

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“…In a multi-institutional series (Ost et al , 2016a), reporting the safety and efficacy of SBRT for patients diagnosed with ⩽3 metachronous nodal recurrences treated with SBRT, ADT start was delayed by more than 3 years (44 months, range 17–70 months). The authors emphasise the possibility of delaying ADT treatment and, therefore, the onset of endocrine resistance situation.…”

Section: Discussionmentioning

confidence: 99%

“…In the setting of oligometastatic PC, the adoption of oligometastases-directed stereotactic body radiation therapy (SBRT) could potentially achieve local disease control in selected patients with negligible toxicity (Casamassima et al , 2011; Ahmed et al , 2013; Jereczek-Fossa et al , 2012; Muldermans et al , 2016; Ost et al , 2016a, 2016b). In several cases, the site of progression after SBRT for oligometastatic PC recurrences is close to previous treatment volume.…”

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confidence: 99%

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Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study

et al. 2017

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Background:The aim of the present study is to evaluate the impact of metastases-directed stereotactic body radiotherapy in two groups of oligometastatic prostate cancer (PC) patients: oligorecurrent PC and oligoprogressive castration-resistant PC (oligo-CRPC).Methods:Inclusion criteria of the present multicentre retrospective analysis were: (1) oligorecurrent PC, defined as the presence of 1–3 lesions (bone or nodes) detected with choline positron emission tomography or CT plus bone scan following biochemical recurrence; (2) oligo-CRPC, defined as metastases (bone or nodes) detected after a prostatic-specific antigen rise during androgen deprivation therapy (ADT). Primary end points were: distant progression-free survival (DPFS) and ADT-free survival in oligorecurrent PC patients; DPFS and second-line systemic treatment-free survival in oligo-CRPC patients.Results:About 100 patients with oligorecurrent PC (139 lesions) and 41 with oligo-CRPC (70 lesions), treated between March 2010 and April 2016, were analysed. After a median follow-up of 20.4 months, in the oligorecurrent group 1- and 2-year DPFS were 64.4 and 43%. The rate of LC was 92.8% at 2 years. At a median follow-up of 23.4 months, in the oligo-CRPC group 1- and 2-year DPFS were 43.2 and 21.6%. Limitations include the retrospective design.Conclusions:Stereotactic body radiotherapy seems to be a useful treatment both for oligorecurrent and oligo-CRPC.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study

et al. 2017

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“…Pooled analysis of 119 patients, with ≤3 metastases, treated with SBRT has been reported by Ost [60, 61]. The local control was found to be superior when SBRT delivered a BED ≥100 Gy.…”

Section: Extreme Hypofractionationmentioning

confidence: 99%

“…Pooled analysis [60] of a subset of 72 patients with oligorecurrent nodal disease, treated with SBRT at a dose of 5Gy per fraction to a BED of at least 80Gy, has reported a median distant progression-free survival of 21 months, with a progression-free survival of 34%/13% at 3/5 years, respectively. Late grade 1 and 2 toxicity was reported in 17 and 4% of patients, respectively.…”

Section: Extreme Hypofractionationmentioning

confidence: 99%

The Role of Hypofractionated Radiotherapy in Prostate Cancer

2017

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Purpose of ReviewIt is now accepted that prostate cancer has a low alpha/beta ratio, establishing a strong basis for hypofractionation of prostate radiotherapy. This review focuses on the rationale for hypofractionation and presents the evidence base for establishing moderate hypofractionation for localised disease as the new standard of care. The emerging evidence for extreme hypofractionation in managing localized and oligometastatic prostate cancer is reviewed.Recent FindingsThe 5-year efficacy and toxicity outcomes from four phase III studies have been published within the last 12 months. These studies randomizing over 6000 patients to conventional fractionation (1.8–2.0 Gy per fraction) or moderate hypofractionation (3.0–3.4 Gy per fraction). They demonstrate hypofractionation to be non-inferior to conventional fractionation.SummaryModerate hypofractionation for localized prostate cancer is safe and effective. There is a growing body of evidence in support of extreme hypofractionation for localized prostate cancer. Extreme hypofractionation may have a role in managing prostate oligometastases, but further studies are needed.

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“…This latter approach has already demonstrated it can delay the need for additional therapies between 17–70 months in patients with nodal recurrence. 51 …”

Section: Lymphotropic Nanoparticle Mrimentioning

confidence: 99%

Advances in Prostate Cancer Magnetic Resonance Imaging and Positron Emission Tomography-Computed Tomography for Staging and Radiotherapy Treatment Planning

Moghanaki

Türkbey

Vapiwala

et al. 2017

Seminars in Radiation Oncology

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Conventional prostate cancer staging strategies have limited accuracy to define the location, grade, and burden of disease. Evaluations have historically relied upon prostate specific antigen levels, digital rectal examinations, random systematic biopsies, computed tomography, pelvic lymphadenectomy, and/or 99mTc-MDP bone scans. Today, risk-stratification tools incorporate these data in a weighted format to guide management. However, the limitations and potential consequences of their uncertainties are well-known. Inaccurate information may contribute to under-staging and under-treatment, or over-staging and over-treatment. Meanwhile, advances in multi-parametric MRI, whole body MRI, lymphotropic-nanoparticle MRI, and positron emission tomography are now available to improve the accuracy of risk stratification to facilitate more informed medical decisions. They also guide radiation oncologists to develop more accurate treatment plans. This review provides a primer to incorporate these advances into routine clinical workflow.

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Pattern of Progression after Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Nodal Recurrences

Cited by 106 publications

References 22 publications

Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study

Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study

The Role of Hypofractionated Radiotherapy in Prostate Cancer

Advances in Prostate Cancer Magnetic Resonance Imaging and Positron Emission Tomography-Computed Tomography for Staging and Radiotherapy Treatment Planning

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