Stereotactic radiotherapy of nodal oligometastases from prostate cancer: a prisma-compliant systematic review

Zamagni, Alice; Bonetti, Mattia; Buwenge, M.; Macchia, G.; Deodato, F.; Cilla, Savino; Galietta, Erika; Strigari, Lidia; Cellini, Francesco; Tagliaferri, Luca; Cammelli, Silvia; Morganti, Alessio Giuseppe

doi:10.1007/s10585-022-10183-6

Cited by 7 publications

(14 citation statements)

References 58 publications

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“…The review also reported generally low rates of acute toxicity after SBRT. Specifically, acute and late G1-G2 toxicity rates were about 1.9% and on average severe acute and late toxicities ≥G3 occurred in about 0.6% of cases (12). This date is in line with our prospective series in which no acute and late toxicity episodes occurred.…”

Section: Discussionsupporting

confidence: 89%

“…To our knowledge, the present is the largest prospective study of 1.5T lymphnode SBRT on MR-linac in patients with PCa. Previous evidence, mainly retrospective on the use of SBRT in the PCa lymphnode oligometastases with conventional linacs reported local control rates around 93% at two years (10)(11)(12). In our experience, in line with these previous experiences, the 2-year local control rate was 94.5%.…”

Section: Discussionsupporting

confidence: 87%

“…In our study, the 1-year PFS was 49.8%, in line with these previous experiences. There is currently no robust evidence on the timing of onset and duration of ADT concomitant with SBRT, as highlighted by a recent review (12) which analyzed 15 studies of SBRT in oligometastatic PCa patients. The authors reported a high heterogeneity in ADT administration concomitant with SBRT in a range between 33% and 100%, and a duration between 14.5 and 17.5 months.…”

Section: Discussionmentioning

confidence: 99%

“…Lymphnode metastases are a particular site of PCa oligometastatic disease amenable of MDT and might identify a less severe degree of metastatic PCa (9). Several evidence, both prospective and retrospective, evaluated the role of stereotactic body radiotherapy (SBRT) in the management of lymphnode oligometastases, reporting few side effects and adequate local control level (10)(11)(12). The widespread use of metabolic imaging in the very early phase of the PCa metastatic disease have permitted the early identification of metastatic lesions, also infracentimetrical (13).…”

Section: Introductionmentioning

confidence: 99%

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1.5T MR-Guided Daily-Adapted SBRT on Lymphnode Oligometastases from Prostate Cancer

Nicosia¹,

Trapani²,

Rigo³

et al. 2022

Preprint

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Introduction: The aim of our study was to evaluate the efficacy and toxicity of a daily-adaptive MR-guided SBRT on 1.5 T MR-linac in patients affected by lymphnode oligometastases from PCa. Materials and Methods: The present study is a prospective observational study conducted in a single institution (protocol n°: MRI / LINAC n. 23748). Patients with oligometastatic lymphnodes from PCa treated with daily-adaptive MR-guided SBRT on 1.5T MR-linac were included in the study. Minimum required follow-up of 3 months after SBRT. Primary end-point was local progression-free survival (LPFS). Secondary end-points were: nodal progression-free survival (NPFS), and progression-free survival (PFS), and toxicity. Results: 118 lymphnode oligometastases from PCa were treated with daily-adaptive 1.5T MR-guided SBRT in 63 oligometastatic patients. 63.5% patients were oligoprogressive and 36.5% oligoprogressive. Two-year LPFS was 94.5%. Median NPFS was 22.3 months, and the 2-year NPFS was 46.5%. Having received hormone therapy before SBRT was correlated with lower NPFS at the multivariate analysis (1-y NPFS 87.1% versus 42.8%; p= 0.002 - HR 0.199, 95% CI 0.073-0.549). Furthermore, the oligorecurrent state during ADT was correlated with a lower NPFS than the oligoprogressive state. Median PFS was 10.3 months, the 2-year PFS was 32.4%. Patients treated with hormone therapy before SBRT had a significantly lower 1-year PFS the others (28% versus 70.4%; p= 0.01 - HR 0.259, 95% CI 0.117-0.574). No acute and late toxicities occurred during treatment. Conclusion: the present is the largest prospective study of 1.5T lymphnode SBRT on MR-linac in patients with PCa. Lymphnode SBRT by 1.5T MR-linac provides high local control rates with an excellent toxicity profile.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

1.5T MR-Guided Daily-Adapted SBRT on Lymphnode Oligometastases from Prostate Cancer

Nicosia¹,

Trapani²,

Rigo³

et al. 2022

Preprint

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“…Additionally, local therapy can potentially benefit patients with oligometastatic disease, as well. A recent systematic review by Zamagni et al evaluating the potential benefit of SBRT in patients with nodal oligometastatic disease secondary to prostate cancer, for example, found that SBRT was safe, offered high rates of local control, and allowed for a delay in the initiation of androgen deprivation therapy [ 14 ]. Given the potential mechanistic differences in oligoprogression in patients on ICIs, local therapy may be of particular benefit to this patient population.…”

Section: Introductionmentioning

confidence: 99%

Oligoprogression of Solid Tumors on Immune Checkpoint Inhibitors: The Impact of Local Ablative Radiation Therapy

et al. 2022

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The breakthrough of a limited number of clones while on immune checkpoint inhibitors (ICIs), known as oligoprogression, has been previously described. The benefit of ablative radiation therapy (RT) directed at these clones, as opposed to changing systemic therapy, is unclear. We analyzed 30 patients with advanced solid tumors, the majority of whom (23/30, 86.7%) had either hepatocellular or urothelial carcinoma, who experienced oligoprogression on ICIs and were referred for RT. In this study, oligoprogression was defined as having experienced progression at three or fewer metastatic sites outside of the brain after achieving at least stable disease on ICIs for a minimum of three months. The median time to oligoprogression was 11.1 months from the initiation of immunotherapy. 24 patients had one oligoprogressive lesion and six had two. The median radiation dose delivered was 4650 cGy in a median of five fractions. The median progression-free survival (PFS) after RT was 7.1 months, and the time to oligoprogression was not a significant predictor of PFS2. 26 patients continued on ICIs after RT. While 17 patients subsequently progressed, 15 did so at three or fewer metastatic sites and could have theoretically stood to benefit from an additional course of salvage RT to further extend the lifespan of their ICIs. Overall survival at 6, 12, and 24 months was 100.0%, 96.3%, and 82.8%, respectively. These results suggest that RT may provide a PFS benefit and extend the lifespan of ICIs in patients who experience oligoprogression. Regardless of PFS, however, overall survival in this population appears to be excellent.

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Safety and Tolerability of Online Adaptive High-Field Magnetic Resonance–Guided Radiotherapy

Westerhoff,

Daamen,

Christodouleas

et al. 2024

JAMA Netw Open

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ImportanceIn 2018, the first online adaptive magnetic resonance (MR)-guided radiotherapy (MRgRT) system using a 1.5-T MR–equipped linear accelerator (1.5-T MR-Linac) was clinically introduced. This system enables online adaptive radiotherapy, in which the radiation plan is adapted to size and shape changes of targets at each treatment session based on daily MR-visualized anatomy.ObjectiveTo evaluate safety, tolerability, and technical feasibility of treatment with a 1.5-T MR-Linac, specifically focusing on the subset of patients treated with an online adaptive strategy (ie, the adapt-to-shape [ATS] approach).Design, Setting, and ParticipantsThis cohort study included adults with solid tumors treated with a 1.5-T MR-Linac enrolled in Multi Outcome Evaluation for Radiation Therapy Using the MR-Linac (MOMENTUM), a large prospective international study of MRgRT between February 2019 and October 2021. Included were adults with solid tumors treated with a 1.5-T MR-Linac. Data were collected in Canada, Denmark, The Netherlands, United Kingdom, and the US. Data were analyzed in August 2023.ExposureAll patients underwent MRgRT using a 1.5-T MR-Linac. Radiation prescriptions were consistent with institutional standards of care.Main Outcomes and MeasuresPatterns of care, tolerability, and technical feasibility (ie, treatment completed as planned). Acute high-grade radiotherapy-related toxic effects (ie, grade 3 or higher toxic effects according to Common Terminology Criteria for Adverse Events version 5.0) occurring within the first 3 months after treatment delivery.ResultsIn total, 1793 treatment courses (1772 patients) were included (median patient age, 69 years [range, 22-91 years]; 1384 male [77.2%]). Among 41 different treatment sites, common sites were prostate (745 [41.6%]), metastatic lymph nodes (233 [13.0%]), and brain (189 [10.5%]). ATS was used in 1050 courses (58.6%). MRgRT was completed as planned in 1720 treatment courses (95.9%). Patient withdrawal caused 5 patients (0.3%) to discontinue treatment. The incidence of radiotherapy-related grade 3 toxic effects was 1.4% (95% CI, 0.9%-2.0%) in the entire cohort and 0.4% (95% CI, 0.1%-1.0%) in the subset of patients treated with ATS. There were no radiotherapy-related grade 4 or 5 toxic effects.Conclusions and RelevanceIn this cohort study of patients treated on a 1.5-T MR-Linac, radiotherapy was safe and well tolerated. Online adaptation of the radiation plan at each treatment session to account for anatomic variations was associated with a low risk of acute grade 3 toxic effects.

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Stereotactic radiotherapy of nodal oligometastases from prostate cancer: a prisma-compliant systematic review

Cited by 7 publications

References 58 publications

1.5T MR-Guided Daily-Adapted SBRT on Lymphnode Oligometastases from Prostate Cancer

1.5T MR-Guided Daily-Adapted SBRT on Lymphnode Oligometastases from Prostate Cancer

Oligoprogression of Solid Tumors on Immune Checkpoint Inhibitors: The Impact of Local Ablative Radiation Therapy

Safety and Tolerability of Online Adaptive High-Field Magnetic Resonance–Guided Radiotherapy

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