Recommendations for radiation therapy in oligometastatic prostate cancer: An ESTRO-ACROP Delphi consensus

Zilli, Thomas; Achard, Vérane; Pra, Alan Dal; Hegemann, Nina Schmidt; Jereczek‐Fossa, Barbara Alicja; Lancia, Andrea; Ingrosso, Gianluca; Alongi, Filippo; Aluwini, S.; Arcangeli, Stefano; Blanchard, Pierre; Moreno, Antonio Conde; Couñago, Felipe; Créhange, G.; Dirix, Piet; Iturriaga, Alfonso Gomez; Gückenberger, Matthias; Pasquier, David; Sargos, P.; Scorsetti, Marta; Supiot, S.; Tree, A.; Zapatero, A.; Guévelou, Jennifer Le; Ost, Piet; Belka, Claus

doi:10.1016/j.radonc.2022.10.005

Cited by 49 publications

(28 citation statements)

References 47 publications

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“…Burdett et al [ 13 ] reported a 7% improvement in the 3-year survival rate when EBRTx was performed in patients with OmPCa with not more than five bone metastases. In addition, the European Society for Radiotherapy and Oncology Guidelines Committee has recently recommended EBRTx in OmPCa [ 40 ]. In contrast, CRP still lacks evidence.…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive prostatectomy may improve oncological outcomes in patients with oligometastatic prostate cancer: An updated systematic review and meta-analysis

et al. 2023

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The oncologic outcomes of cytoreductive prostatectomy (CRP) in oligometastatic prostate cancer (OmPCa) are still controversial. Therefore, we conducted a systematic review and meta-analysis on the oncologic outcome of CRP in OmPCa. OVID-Medline, OVID-Embase, and Cochrane Library databases were searched to identify eligible studies published before January 2023. A total of 11 studies (929 patients), 1 randomized controlled trial (RCT) and 10 non-RCT studies, were included in the final analysis. RCT and non-RCT were further analyzed separately. End points were progression-free-survival (PFS), time to castration-resistant prostate cancer (CRPCa), cancer-specific-survival (CSS) and overall-survival (OS). It was analyzed using hazard ratio (HR) and 95% confidence intervals (CIs). In PFS, in RCT, HR=0.43 (CIs=0.27–0.69) was shown statistically significant, but in non-RCTs, HR=0.50 (CIs=0.20–1.25), there was no statistical difference. And, in time to CRPCa was statistically significant in the CRP group in all analyses (RCT; HR=0.44; CIs=0.29–0.67) (non-RCTs; HR=0.64; CIs=0.47–0.88). Next, CSS was not statistically different between the two groups (HR=0.63; CIs=0.37–1.05). Finally, OS showed better results in the CRP group in all analyses (RCT; HR=0.44; CIs=0.26–0.76) (non-RCTs; HR=0.59; CIs=0.37–0.93). Patients who received CRP in OmPCa showed better oncologic outcomes compared to controls. Notably, time to CRPC and OS showed significantly improved compared with control. We recommend that experienced urologists who are capable of managing complications consider CRP as a strategy to achieve good oncological outcomes in OmPCa. However, since most of the included studies are non-RCT studies, caution should be exercised in interpreting the results.

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Section: Discussionmentioning

confidence: 99%

Cytoreductive prostatectomy may improve oncological outcomes in patients with oligometastatic prostate cancer: An updated systematic review and meta-analysis

et al. 2023

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“…Currently, ESTRO recommends metastases-directed radiotherapy strategies and focuses on the role of combination treatments in oligometastatic prostate cancer patients, as declared by Zilli et al (20) .…”

Section: Discussionmentioning

confidence: 99%

Quality of Life of Metastatic Prostate Cancer Patients Treated with Prostate Radiotherapy

Ayoub,

Zamzam,

Elsemary

et al. 2023

Preprint

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Background The impact of prostate radiotherapy on patient-reported health-related quality of life (HRQoL) significantly influences the outcomes of metastatic prostate cancer. We measured and compared HRQoL of metastatic prostate cancer patients who received cytoreductive prostate radiotherapy. Methods Between November 23, 2020, and November 21, 2022, we recruited 70 metastatic prostate cancer patients at the Department of Clinical Oncology at Suez Canal University Hospital. Patients were eligible if they had synchronous and metachronous histopathological confirmed metastatic adenocarcinoma and an Eastern Cooperative Oncology Group performance status ≤ 2. Random allocation was performed for either definitive local radiotherapy concurrent with the standard androgen deprivation therapy (ADT) or to the standard ADT alone. Definitive radiotherapy was delivered conventionally (70 Gy/35 fractions) or through the hypofractionated regimen (55 Gy/20 fractions). Patients completed the comprehensive European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-PR25) at baseline, then at three-month intervals for one year. The primary endpoint was patient-reported HRQoL, with secondary endpoints including toxicity and radiographic progression-free survival (rPFS). Mean HRQoL scores between groups were compared using the independent samples t-test. Results We observed clinically significant improvements in urinary and bowel functions between baseline, 3-month, 6-month, and 12-month intervals after receiving definitive prostate radiotherapy. Patients in the radiotherapy group had significantly lower urinary symptoms scores than the control group. However, sexual activity and functioning showed significant deterioration. Conclusion Cytoreductive prostate radiotherapy in metastatic prostate cancer patients significantly improved urinary functioning, preserved bowel functioning but was associated with worsening of sexual functioning. Trial Registration This trial was registered on (27/04/2023) with pactr.samrc.ac.za, PACTR202305854600529, URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25510

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“…Notably, more than half of those surveyed did not differentiate between synchronous and metachronous disease, even though the evidence for MDT in PCa primarily stems from metachronous omPCa [ 3 ▪ ]. Similarly, the recent ESTRO-ACROP Delphi consensus reflected experts’ inclination toward offering MDT in all de novo oligometastatic settings (as per ESTRO/EORTC nomenclature [ 5 ]), at the same time acknowledging the lack of conclusive evidence [ 6 ].…”

Section: General Overview Of Metastasis-directed Therapy In Context O...mentioning

confidence: 99%

Metastasis-directed therapy in oligometastatic prostate cancer

Miszczyk,

Soeterik,

Marra

et al. 2024

Current Opinion in Urology

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Purpose of review To summarize the recent findings on the subject of metastasis-directed therapy (MDT) in the treatment of oligometastatic prostate cancer (omPCa). Recent findings Evidence from two randomized clinical trials (RCTs) and a meta-analysis show favorable toxicity profiles, and the potential to delay androgen-deprivation therapy (ADT) for up to two years in nearly half of patients with metachronous hormone-sensitive omPCa. Another RCT showed promising results of MDT as treatment-escalation method combined with androgen receptor signaling inhibitors (ARSI) in first-line treatment for castration-resistant omPCa. Surveys by radiation oncologists and consensus guidelines advocate for MDT across various omPCa scenarios. Multiple single-arm trials present encouraging results; however, the evidence for the benefit of MDT is still weak requiring further investigation to assess its impact on pivotal endpoints, such as survival and quality of life. Summary MDT is a promising approach in omPCa, and can be used to defer ADT in newly diagnosed metachronous omPCa patients, or to add to ARSI treatment at first diagnosis of castration-resistance. Ongoing prospective trials are needed to guide its optimal utilization in other settings, and patients should be informed about the evolving landscape of systemic therapies with proven survival benefits alongside MDT options.

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Recommendations for radiation therapy in oligometastatic prostate cancer: An ESTRO-ACROP Delphi consensus

Cited by 49 publications

References 47 publications

Cytoreductive prostatectomy may improve oncological outcomes in patients with oligometastatic prostate cancer: An updated systematic review and meta-analysis

Cytoreductive prostatectomy may improve oncological outcomes in patients with oligometastatic prostate cancer: An updated systematic review and meta-analysis

Quality of Life of Metastatic Prostate Cancer Patients Treated with Prostate Radiotherapy

Metastasis-directed therapy in oligometastatic prostate cancer

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