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For: Casamassima F, Masi L, Menichelli C, Bonucci I, Casamassima E, Lazzeri M, Gulisano M, Aterini S. Efficacy of eradicative radiotherapy for limited nodal metastases detected with choline PET scan in prostate cancer patients. Tumori 2011;97:49-55. [PMID: 21528664 DOI: 10.1177/030089161109700110] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

For:	Casamassima F, Masi L, Menichelli C, Bonucci I, Casamassima E, Lazzeri M, Gulisano M, Aterini S. Efficacy of eradicative radiotherapy for limited nodal metastases detected with choline PET scan in prostate cancer patients. Tumori 2011;97:49-55. [PMID: 21528664 DOI: 10.1177/030089161109700110] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

Number

Cited by Other Article(s)

Cuccia F, Tamburo M, Piras A, Mortellaro G, Iudica A, Daidone A, Federico M, Zagardo V, Ferini G, Marletta F, Spatola C, Fazio I, Filosto S, Pergolizzi S, Ferrera G. Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience. MEDICINA (KAUNAS, LITHUANIA) 2023;59:1442. [PMID: 37629732 PMCID: PMC10456704 DOI: 10.3390/medicina59081442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]

Abstract

Background: The favorable role of SBRT for lymph-nodal oligometastases from prostate cancer has been reported by several retrospective and prospective experiences, suggesting a more indolent natural history of disease when compared to patients with bone oligometastases. This retrospective multicenter study evaluates the outcomes of a cohort of patients treated with stereotactic body radiotherapy for lymph-nodal oligometastases. Methods: Inclusion criteria were up to five lymph-nodal oligometastases detected either with Choline-PET or PSMA-PET in patients naïve for ADT or already ongoing with systemic therapy and at least 6 Gy per fraction for SBRT. Only patients with exclusive lymph-nodal disease were included. The primary endpoint of the study was LC; a toxicity assessment was retrospectively performed following CTCAE v4.0. Results: A total of 100 lymph-nodal oligometastases in 69 patients have been treated with SBRT between April 2015 and November 2022. The median age was 73 years (range, 60-85). Oligometastatic disease was mainly detected with Choline-PET in 47 cases, while the remaining were diagnosed using PSMA-PET, with most of the patients treated to a single lymph-nodal metastasis (48/69 cases), two in 14 cases, and three in the remaining cases. The median PSA prior to SBRT was 1.35 ng/mL (range, 0.3-23.7 ng/mL). Patients received SBRT with a median total dose of 35 Gy (range, 30-40 Gy) in a median number of 5 (range, 3-6) fractions. With a median follow-up of 16 months (range, 7-59 months), our LC rates were 95.8% and 86.3% at 1 and 2 years. DPFS rates were 90.4% and 53.4%, respectively, at 1 and 2 years, with nine patients developing a sequential oligometastatic disease treated with a second course of SBRT. Polymetastatic disease-free survival (PMFS) at 1 and 2 years was 98% and 96%. Six patients needed ADT after SBRT for a median time of ADT-free survival of 15 months (range, 6-22 months). The median OS was 16 months (range, 7-59) with 1- and 2-year rates of both 98%. In multivariate analysis, higher LC rates and the use of PSMA-PET were related to improved DPFS rates, and OS was significantly related to a lower incidence of distant progression. No G3 or higher adverse events were reported. Conclusions: In our experience, lymph-nodal SBRT for oligometastatic prostate cancer is a safe and effective option for ADT delay with no severe toxicity.

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Zamagni A, Bonetti M, Buwenge M, Macchia G, Deodato F, Cilla S, Galietta E, Strigari L, Cellini F, Tagliaferri L, Cammelli S, Morganti AG. Stereotactic radiotherapy of nodal oligometastases from prostate cancer: a prisma-compliant systematic review. Clin Exp Metastasis 2022;39:845-863. [PMID: 35980556 PMCID: PMC9637632 DOI: 10.1007/s10585-022-10183-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/04/2022] [Indexed: 12/25/2022]

Affiliation(s)

Alice Zamagni Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy.
Mattia Bonetti Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
Milly Buwenge Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
Gabriella Macchia Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
Francesco Deodato Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
Savino Cilla Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
Erika Galietta Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
Lidia Strigari Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Francesco Cellini Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica ed Ematologia, Rome, Italy Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
Luca Tagliaferri Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica ed Ematologia, Rome, Italy
Silvia Cammelli Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Alessio Giuseppe Morganti Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

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Alberto M, Yim A, Papa N, Siva S, Ischia J, Touijer K, Eastham JA, Bolton D, Perera M. Role of PSMA PET-guided metastases-directed therapy in oligometastatic recurrent prostate cancer. Front Oncol 2022;12:929444. [PMID: 36059632 PMCID: PMC9433573 DOI: 10.3389/fonc.2022.929444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open

Stratification of Oligometastatic Prostate Cancer Patients by Liquid Biopsy: Clinical Insights from a Pilot Study. Biomedicines 2022;10:biomedicines10061321. [PMID: 35740343 PMCID: PMC9219949 DOI: 10.3390/biomedicines10061321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 02/01/2023] Open

Cozzi S, Botti A, Timon G, Blandino G, Najafi M, Manicone M, Bardoscia L, Ruggieri MP, Ciammella P, Iotti C. Prognostic factors, efficacy, and toxicity of involved-node stereotactic body radiation therapy for lymph node oligorecurrent prostate cancer : An investigation of 117 pelvic lymph nodes. Strahlenther Onkol 2021;198:700-709. [PMID: 34757443 DOI: 10.1007/s00066-021-01871-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/17/2021] [Indexed: 12/09/2022]

Abstract

BACKGROUND

The optimal radiotherapy regimen is not yet defined in the setting of oligorecurrent prostate cancer (oligorPC). There is evidence of high variability in treatment protocols among different centers worldwide, and no international consensus guidelines on treatment volumes, radiation schedules, and techniques. The purpose of the present retrospective study is to evaluate the efficacy and safety of involved-pelvic-node stereotactic body radiotherapy (SBRT) for oligorPC.

MATERIALS AND METHODS

Patients with pelvic node oligorPC following primary surgery, radical radiotherapy, or salvage radiotherapy for biochemical or local relapse of prostate cancer who underwent involved-node SBRT with biological effective dose (BED) > 100 Gy, with or without concurrent and adjuvant androgen deprivation therapy (ADT), were retrospectively evaluated. Biochemical progression-free survival (bPFS), distant progression-free survival (DPFS), overall survival (OS), possible prognostic factors, and toxicity outcomes were investigated.

RESULTS

From November 2012 to December 2019, 74 patients fitted the selection criteria. A total of 117 lesions were treated. Median follow-up was 31 months (range 6-89). Concurrent ADT was administered in 58.1% of patients. The 1‑year, 2‑year, and 3‑year DPFS was 77%, 37%, and 19%, respectively; the 1‑year, 2‑year, and 3‑year OS was 98%, 98%, and 95%, respectively. The presence of a single target lesion was associated with a statistically significant impact on OS. No in-field recurrence occurred. Patients who reached early prostate-specific antigen (PSA) nadir (< 3 months after SBRT) had a lower 3‑year survival (p = 0.004). The value of PSA nadir after SBRT and the time between primary treatment and SBRT had an impact on bPFS. Concomitant ADT was associated with improved DPFS. No acute or early late (> 6 months) genitourinary and gastrointestinal adverse events of any grade were reported, albeit with relatively short median follow-up.

CONCLUSION

SBRT is a safe and effective treatment for oligorPC, with a 100% local control rate in our series. It is not possible to clearly assess the opportunity to postpone ADT prescription in patients with two or more nodal metastases. The number of secondary lesions, time-to-nadir PSA, PSA nadir value, and the time interval between primary treatment and SBRT were identified as prognostic factors. Future prospective randomized studies are desirable to better understand the still open questions regarding the oligorecurrent prostate cancer state.

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Stereotactic body radiotherapy to lymph nodes in oligoprogressive castration-resistant prostate cancer patients: a post hoc analysis from two phase I clinical trials. Clin Exp Metastasis 2021;38:519-526. [PMID: 34651242 DOI: 10.1007/s10585-021-10126-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]

Abstract

The prognosis of prostate cancer (PC) is generally favorable but the incidence of metastases is relatively high after the treatment of the primary tumor, especially in high-risk patients. Fractionated stereotactic body radiotherapy (SBRT) or single fraction stereotactic body radiosurgery (SRS) are emerging treatment options in this setting. However, data on SBRT/SRS in patients with metastatic castration-resistant PC (mCRPC) are largely lacking, particularly in subjects with nodal lesions. Therefore, we evaluated outcomes and toxicity recorded in mCRPC patients with nodal oligoprogression. Patients included in this analysis had ≤ 5 metastatic sites without visceral lesions and underwent SBRT/SRS on nodal metastases. Thirty-eight patients carrying out 61 nodal metastases were analyzed. The median SRS dose was 20 Gy (range 12-24 Gy) and the most common schedule was 20 Gy (44.8%). The median SBRT dose was 45 Gy (range 20-50 Gy) and the most common regimen was 45 Gy in 5 fractions (37.9%). Thirty-seven patients (97.4%) showed only grade 0-1 acute toxicity while one patient reported grade 2 dysphagia. In terms of late toxicity, one grade 2 laryngeal, one grade 1 skin and one grade 1 gastrointestinal toxicities were recorded. Two-year actuarial local control (LC), distant progression-free survival, progression-free survival (PFS) and overall survival were 94.0, 47.2, 47.2, and 90.2%, respectively. Two-year next line systemic therapy-free survival (NEST-FS) was 67.7%. In conclusion, the efficacy in terms of LC of SBRT/SRS in patients with nodal metastases from PC was confirmed. Moreover, this analysis suggests the efficacy in terms of PFS and NEST-FS also in the setting of oligoprogressive PC. In fact, about one-third of patients were free from progressive disease and two-third of subjects did not require hormonal therapy switch or discontinuation three years after treatment.

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Systematic review of stereotactic body radiotherapy for nodal metastases. Clin Exp Metastasis 2021;38:11-29. [PMID: 33452954 DOI: 10.1007/s10585-020-10071-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]

Schmidt Hegemann NS, Rogowski P, Eze C, Schäfer C, Stief C, Lang S, Spohn S, Steffens R, Li M, Gratzke C, Schultze-Seemann W, Ilhan H, Fendler WP, Bartenstein P, Ganswindt U, Buchner A, Grosu AL, Belka C, Meyer PT, Kirste S, Zamboglou C. Outcome After 68Ga-PSMA-11 versus Choline PET-Based Salvage Radiotherapy in Patients with Biochemical Recurrence of Prostate Cancer: A Matched-Pair Analysis. Cancers (Basel) 2020;12:E3395. [PMID: 33207785 PMCID: PMC7698293 DOI: 10.3390/cancers12113395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022] Open

Affiliation(s)

Nina-Sophie Schmidt Hegemann Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
Paul Rogowski Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
Chukwuka Eze Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
Christian Schäfer Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
Christian Stief Department of Urology, University Hospital, 81377 LMU Munich, Germany; (C.S.); (A.B.)
Sebastian Lang Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.)
Simon Spohn Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.)
Rieke Steffens Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
Minglun Li Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.)
Christian Gratzke Department of Urology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.G.); (W.S.-S.)
Wolfgang Schultze-Seemann Department of Urology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.G.); (W.S.-S.)
Harun Ilhan Department of Nuclear Medicine, University Hospital, 81377 LMU Munich, Germany; (H.I.); (P.B.)
Wolfgang Peter Fendler Department of Nuclear Medicine, University of Duisburg-Essen, 47057 Essen, Germany; German Cancer Consortium (DKTK), University Hospital Essen, 45147 Essen, Germany
Peter Bartenstein Department of Nuclear Medicine, University Hospital, 81377 LMU Munich, Germany; (H.I.); (P.B.)
Ute Ganswindt Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, 6020 Innsbruck, Austria;
Alexander Buchner Department of Urology, University Hospital, 81377 LMU Munich, Germany; (C.S.); (A.B.)
Anca-Ligia Grosu Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.) German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany
Claus Belka Department of Radiation Oncology, University Hospital, 81377 LMU Munich, Germany; (N.-S.S.H.); (P.R.); (C.E.); (C.S.); (R.S.); (M.L.); (C.B.) German Cancer Consortium (DKTK), Partner Site Munich, 81377 Munich, Germany
Philipp Tobias Meyer Department of Nuclear Medicine, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
Simon Kirste Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.)
Constantinos Zamboglou Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.L.); (S.S.); (A.-L.G.); (S.K.) German Cancer Consortium (DKTK), Partner Site Freiburg, 79106 Freiburg, Germany Bertha-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany

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Reshko LB, Richardson MK, Spencer K, Kersh CR. Stereotactic Body Radiation Therapy (SBRT) in Pelvic Lymph Node Oligometastases. Cancer Invest 2020;38:599-607. [PMID: 32715780 DOI: 10.1080/07357907.2020.1801713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]

Achard V, Bottero M, Rouzaud M, Lancia A, Scorsetti M, Filippi AR, Franzese C, Jereczek-Fossa BA, Ingrosso G, Ost P, Zilli T. Radiotherapy treatment volumes for oligorecurrent nodal prostate cancer: a systematic review. Acta Oncol 2020;59:1224-1234. [PMID: 32536241 DOI: 10.1080/0284186x.2020.1775291] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Stereobody radiotherapy for nodal recurrences in oligometastatic patients: a pooled analysis from two phase I clinical trials. Clin Exp Metastasis 2020;37:519-529. [PMID: 32495238 DOI: 10.1007/s10585-020-10039-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]

Albisinni S, Van Damme J, Aoun F, Bou Kheir G, Roumeguère T, De Nunzio C. A systematic review of imaging-guided metastasis-directed therapy for oligorecurrent prostate cancer: revolution or devolution? MINERVA UROL NEFROL 2020;72:279-291. [DOI: 10.23736/s0393-2249.20.03675-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]

Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Recurrence: A Meta-analysis. Am J Clin Oncol 2020;43:73-81. [PMID: 31809327 DOI: 10.1097/coc.0000000000000635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]

Glicksman RM, Metser U, Valliant J, Chung PW, Fleshner NE, Bristow RG, Green D, Finelli A, Hamilton R, Stanescu T, Hussey D, Catton C, Gospodarowicz M, Warde P, Bayley A, Breen S, Vines D, Jaffray DA, Berlin A. [¹⁸F]DCFPyL PET-MRI/CT for unveiling a molecularly defined oligorecurrent prostate cancer state amenable for curative-intent ablative therapy: study protocol for a phase II trial. BMJ Open 2020;10:e035959. [PMID: 32327479 PMCID: PMC7204865 DOI: 10.1136/bmjopen-2019-035959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open

Abstract

INTRODUCTION

The oligometastatic (OM) disease hypothesis of an intermediate metastatic state with limited distant disease deposits amenable for curative therapies remains debatable. Over a third of prostate cancer (PCa) patients treated with radical prostatectomy and postoperative radiotherapy experience disease recurrence; these patients are considered incurable by current standards. Often the recurrence cannot be localised by conventional imaging (CT and bone scan). Combined anatomical imaging with CT and/or MR with positron emission tomography (PET) using a novel second-generation prostate-specific membrane antigen (PSMA) probe, [¹⁸F]DCFPyL, is a promising imaging modality to unveil disease deposits in these patients. A new and earlier molecularly defined oligorecurrent (OR) state may be amenable to focal-targeted ablative curative-intent therapies, such as stereotactic ablative radiotherapy (SABR) or surgery, thereby significantly delaying or completely avoiding the need for palliative therapies in men with recurrent PCa after maximal local treatments.

METHODS AND ANALYSIS

This ongoing single-institution phase II study will enrol up to 75 patients total, to include up to 37 patients with response-evaluable disease, who have rising prostate-specific antigen (range 0.4-3.0 ng/mL) following maximal local therapies with no evidence of disease on conventional imaging. These patients will undergo [¹⁸F]DCFPyL PET-MR/CT imaging to detect disease deposits, which will then be treated with SABR or surgery. The primary endpoints are performance of [¹⁸F]DCFPyL PET-MR/CT, and treatment response rates following SABR or surgery. Demographics and disease characteristics will be summarised and analysed descriptively. Response rates will be described with waterfall plots and proportions.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the institutional Research Ethics Board. All patients will provide written informed consent. [¹⁸F]DCFPyL has approval from Health Canada. The results of the study will be disseminated by the principal investigator. Patients will not be identifiable as individuals in any publication or presentation of this study.

TRIAL REGISTRATION NUMBERS

NCT03160794.

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Affiliation(s)

Rachel M Glicksman Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
Ur Metser Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
John Valliant Centre for Probe Development and Commercialization, McMaster University, Hamilton, Ontario, Canada
Peter W Chung Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
Neil E Fleshner Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Robert G Bristow Division of Cancer Sciences, Faculty of Biology, Health and Medicine, University of Manchester; Cancer Research UK Manchester Institute and Manchester Cancer Research Centre; The Christie NHS Foundation Trust, Manchester, UK
David Green Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
Antonio Finelli Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Robert Hamilton Department of Surgical Oncology, Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Teodor Stanescu Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
Douglas Hussey Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
Charles Catton Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
Mary Gospodarowicz Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
Padraig Warde Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
Andrew Bayley Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
Stephen Breen Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Doug Vines Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada
David A Jaffray Office of the Chief Technology and Digital Officer; Department of Radiation Physics; Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Alejando Berlin Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada

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Pizzuto DA, Annunziata S, Ieria FP, Caldarella C, Isgrò MA, Lanni V, Bencivenga G, Rufini V, Giordano A. Lung uptake of fluorine-18 fluoroethyl-choline PET-CT in patients with prostate cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2019;63:387-393. [PMID: 29345442 DOI: 10.23736/s1824-4785.18.02985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]

Abstract

BACKGROUND

Metastatic spreading to the lungs is a negative prognostic factor in patients with prostate cancer (PC). Aim of our study was to assess the prevalence of lung PC metastases in patients with fluorine-18 fluoroethyl-choline (F-18-FECh) PET-CT positive lung lesions and the role of Gleason Score (GS) and common biochemical markers in predicting metastatic spreading to the lungs.

METHODS

We retrospectively evaluated the scans of 1283 patients ongoing (F-18-FECh) PET-CT for PC between May 2010 and July 2014. Patients with lung lesion with F-18-FECh uptake were included. Data concerning GS at diagnosis, "trigger" prostate-specific antigen (PSAtr), PSA doubling time (PSAdt), PSA velocity (PSAvel) and ongoing androgen deprivation therapy were collected. PET-CT findings were confirmed by histology or follow-up (FU) and classified as follows: inflammation, primary lung cancer or metastases from tumor other than PC, and lung metastases from PC.

RESULTS

Twenty-two patients with F-18-FECh positive lung lesion and available histology or FU were identified. PSAdt was significantly (P=0.029) shorter in patients with lung metastases from PC (median PSAdt 1.7 months, interquartile range [IQR] 1.5-4.1 months) than in patients without lung PC relapse (median PSAdt 6.7 months, IQR 3.9-7.8); PSAvel was significantly (P=0.019) higher in patients with lung metastases from PC (median PSAvel 3.2 ng/mL/month, IQR 0.65-6.65 ng/mL/month) than in patients without lung PC relapse (median PSAvel 0.3 ng/mL/month, IQR 0.2-0.5 ng/mL/month). Patients with lung metastases from PC had significantly (P=0.006) higher GS at diagnosis (median GS 8) than the other ones (median GS 7).

CONCLUSIONS

Our analysis shows that the prevalence of F-18-FECh positive lung metastases in patients with PC, especially with higher GS at diagnosis, is higher in presence of a steady increase in PSA values, confirmed by higher PSAvel and shorter PSAdt.

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Hrinivich WT, Phillips R, Da Silva AJ, Radwan N, Gorin MA, Rowe SP, Pienta KJ, Pomper MG, Wong J, Tran PT, Kang-Hsin Wang K. Online Prostate-Specific Membrane Antigen and Positron Emission Tomography-Guided Radiation Therapy for Oligometastatic Prostate Cancer. Adv Radiat Oncol 2019;5:260-268. [PMID: 32280826 PMCID: PMC7136645 DOI: 10.1016/j.adro.2019.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/03/2019] [Accepted: 10/11/2019] [Indexed: 12/31/2022] Open

Abstract

Purpose

Stereotactic ablative radiation therapy (SABR) for oligometastatic prostate cancer (OMPC) may improve clinical outcomes, but current challenges in intrafraction tracking of multiple small targets limits treatment accuracy. A biology-guided radiation therapy (BgRT) delivery system incorporating positron emission tomography (PET) detectors is being developed to use radiotracer uptake as a biologic fiducial for intrafraction tumor tracking to improve geometric accuracy. This study simulates prostate-specific membrane antigen (PSMA)-directed BgRT using a cohort from our phase II randomized trial of SABR in men with recurrent hormone sensitive OMPC and compares dose distributions to clinical SABR (CSABR).

Methods and Materials

A research treatment planning system (RTPS) was used to replan 15 patients imaged with PSMA-targeted ¹⁸F-DCFPyL PET/computed tomography and previously treated with CSABR using conventional linear accelerators (linacs). The RTPS models a prototype ring-mounted linac incorporating PET and kilo-voltage computed tomography imaging subsystems and can be used to optimize BgRT plans, as well as research SABR (RSABR) plans, which use the prototype linac without radiotracer guidance. CSABR, RSABR, and BgRT plans were compared in terms of maximum planning target volume (PTV) dose (D_max), mean dose to proximal organs at risk (D_OAR), conformity index, as well as voxel-wise correlation of dose with PET specific uptake values to investigate possible dose-painting effects.

Results

RSABR and BgRT plans resulted in mean ± standard deviation increases in D_max of 4 ± 11% (P = .21) and 18 ± 15% (P < .001) and reductions in D_OAR of –20 ± 19% (P <.001) and –10 ± 19% (P = .02) compared with CSABR. Similar target coverage was maintained with conformity indices of 0.81 ± 0.04 (P < .001) and 0.72 ± 0.08 (P = .44) for RSABR and BgRT compared with 0.74 ± 0.08 for CSABR. Dose and log (specific uptake values) had Pearson correlation coefficients of 0.10 (CSABR), 0.16 (RSABR), and 0.31 (BgRT).

Conclusions

BgRT plans provided similar PTV coverage and conformity compared with CSABR while incorporating underlying PET activity. These results demonstrate feasibility of BgRT optimization enabling online PSMA-targeted, PET-based tracked dose delivery for OMPC.

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Kleinclauss F, Thiery-Vuillemin A. [Oligometastatic prostate cancer management]. Prog Urol 2019;29 Suppl 1:S20-S34. [PMID: 31307628 DOI: 10.1016/s1166-7087(19)30167-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]

Abstract

OBJECTIVE

To review biology and management of oligometastatic prostate cancer.

MATERIAL AND METHODS

Relevant publications were identified through Medline (www. ncbi.nlm.nih.gov), Embase (www.embase.com) and the US National Library of Medicine (www.clinicaltrials.org) databases using the following keywords, alone or in association, «prostate cancer; metastasis; oligo-metastasis». Articles were selected according to methods, language of publication and relevance. After careful selection 99 publications were eligible for our review.

RESULTS

Oligometastatic prostate cancer is a new entity including prostate cancer with a limited number of metastasis. This particular state becomes more frequent with the imaging progresses especially with the common use of new PET imaging with Choline or PSMA. There is no consensus about a strict definition of oligometastatic prostate cancer, number and sites of metastasis vary widely in the literature. Moreover, oligometastatic state can be observed de novo at the time of prostate cancer diagnosis as well as in case of recurrence after a primary treatment. There is actually an important lack of evidence-based medicine and no guidelines regarding treatment can be found. In de novo oligo-metatastatic prostate cancer, treatment of the primary tumor in association with androgen deprivation therapy seems to increase survival in selected patients but this needs to be confirmed by ongoing prospective clinical trials. In recurrent prostate cancer, metastasis directed therapy with or without androgen deprivation therapy is now routinely performed but its impact needs also to be analyzed.

CONCLUSION

In absence of consensus or guidelines, management of prostate cancer should be an individualized, patient-based management taking into account primary tumor stage and grade, number and types of metastasis and patient characteristics.

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Local ablative stereotactic body radiotherapy for oligometastatic prostate cancer. Curr Opin Support Palliat Care 2019;12:351-358. [PMID: 29979320 DOI: 10.1097/spc.0000000000000371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]

Okonogi N, Kaminuma T, Okimoto T, Shinoto M, Yamamoto N, Yamada S, Murata K, Ohno T, Shioyama Y, Tsuji H, Nakano T, Kamada T. Carbon-ion radiotherapy for lymph node oligo-recurrence: a multi-institutional study by the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS). Int J Clin Oncol 2019;24:1143-1150. [PMID: 30968270 PMCID: PMC6687700 DOI: 10.1007/s10147-019-01440-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/02/2019] [Indexed: 01/09/2023]

Palacios-Eito A, Béjar-Luque A, Rodríguez-Liñán M, García-Cabezas S. Oligometastases in prostate cancer: Ablative treatment. World J Clin Oncol 2019;10:38-51. [PMID: 30815370 PMCID: PMC6390116 DOI: 10.5306/wjco.v10.i2.38] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/30/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open

Weichselbaum RR. The 46th David A. Karnofsky Memorial Award Lecture: Oligometastasis—From Conception to Treatment. J Clin Oncol 2018;36:3240-3250. [DOI: 10.1200/jco.18.00847] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open

Loi M, Di Cataldo V, Francolini G, Bonomo P, Masi L, Simontacchi G, Detti B, Greto D, Desideri I, Livi L. Single-Fraction Stereotactic Body Radiotherapy for Oligometastatic Lymph Node Relapse in Prostate Cancer. Oncol Res Treat 2018;41:703-705. [PMID: 30317236 DOI: 10.1159/000491605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/28/2018] [Indexed: 12/24/2022]

Battaglia A, De Meerleer G, Tosco L, Moris L, Van den Broeck T, Devos G, Everaerts W, Joniau S. Novel Insights into the Management of Oligometastatic Prostate Cancer: A Comprehensive Review. Eur Urol Oncol 2018;2:174-188. [PMID: 31017094 DOI: 10.1016/j.euo.2018.09.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 09/04/2018] [Accepted: 09/12/2018] [Indexed: 02/01/2023]

Abstract

CONTEXT

The current standard of care for metastatic prostate cancer (PCa) is androgen deprivation therapy (ADT) plus either docetaxel or abiraterone. Growing evidence suggests that metastasis-directed therapy (MDT) and/or local therapy targeted to the primary tumour (ie, prostate) may be of benefit in the setting of oligometastatic disease. Several prospective studies are underway; however, until robust evidence is available to guide treatment decisions, physicians are challenged with how best to manage patients with oligometastases.

OBJECTIVE

This comprehensive review aims to collate the available evidence to date for a role of MDT and/or prostate-targeted therapy in the setting of oligometastatic PCa, as well as discuss ongoing trials in this setting.

EVIDENCE ACQUISITION

We searched PubMed for the combination of "prostate cancer" and "oligometastatic", "oligometastases", "oligometastasis", "solitary metastases", "stereotactic body radiotherapy", "SBRT", "stereotactic ablative radiotherapy", "SABR", "salvage lymphadenectomy", or "metastasectomy" in publications over the last 20yr. We also searched ClinicalTrials.gov to identify relevant ongoing trials.

EVIDENCE SYNTHESIS

The studies were divided according to the timing of metastasis into synchronous (ie, detected at the time of primary PCa diagnosis) and metachronous (ie, detected after treatment of the primary tumour), and according to treatment modality into MDT (including salvage lymph node dissection [sLND]) and prostate-targeted treatment. For MDT of synchronous/metachronous metastases, we included 16 completed studies and 11 ongoing prospective studies. In the case of sLND for nodal-only recurrence after primary treatment with curative intent, we included 11 completed studies. Finally, for prostate-targeted treatment of synchronous metastatic PCa, we included 25 completed studies and 11 ongoing prospective studies. In selected patients with oligorecurrent disease, early detection and aggressive treatment of metastatic lesions (surgery or radiotherapy) appears to be a feasible strategy and may delay the use of systemic therapies. MDT is a promising option in oligometastatic PCa patients, but more robust data are needed. In the setting of synchronous oligometastatic disease, aggressive cytoreductive treatment needs further data to confirm the benefits.

CONCLUSIONS

In this review, we provide a comprehensive overview of the current literature on the treatment of patients with oligometastatic PCa. The data suggest that although ADT plus either docetaxel or abiraterone remains the mainstay of treatment for mPCa, in oligometastatic PCa, improved outcomes may be achieved with metastasis- and prostate-targeted therapies. The studies included in this review are mainly retrospective in nature, limiting the strength of the evidence they provide. Prospective studies are ongoing, and their results are eagerly awaited.

PATIENT SUMMARY

We reviewed the treatment of patients with prostate cancer that has spread to five sites or fewer. We conclude that while androgen deprivation plus either docetaxel or abiraterone should remain the standard of care, there is evidence that treatment targeted at the metastases and the primary tumour may improve the outcome for the patient and potentially delay the use of systemic treatment.

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Salvage extended field or involved field nodal irradiation in 18F-fluorocholine PET/CT oligorecurrent nodal failures from prostate cancer. Eur J Nucl Med Mol Imaging 2018;46:40-48. [DOI: 10.1007/s00259-018-4159-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]

Oertel M, Scobioala S, Kroeger K, Baehr A, Stegger L, Haverkamp U, Schäfers M, Eich HT. Worth a local treatment? - Analysis of modern radiotherapy concepts for oligometastatic prostate cancer. Radiat Oncol 2018;13:185. [PMID: 30241556 PMCID: PMC6150968 DOI: 10.1186/s13014-018-1118-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/29/2018] [Indexed: 12/03/2022] Open

Lieng H, Hayden AJ, Christie DRH, Davis BJ, Eade TN, Emmett L, Holt T, Hruby G, Pryor D, Shakespeare TP, Sidhom M, Skala M, Wiltshire K, Yaxley J, Kneebone A. Radiotherapy for recurrent prostate cancer: 2018 Recommendations of the Australian and New Zealand Radiation Oncology Genito-Urinary group. Radiother Oncol 2018;129:377-386. [PMID: 30037499 DOI: 10.1016/j.radonc.2018.06.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022]

Affiliation(s)

Hester Lieng Central Coast Cancer Centre, Gosford Hospital, Australia.
Amy J Hayden Sydney West Radiation Oncology, Westmead Hospital, Australia
David R H Christie Genesis Cancer Care, Australia; Department of Health Sciences and Medicine, Bond University, Gold Coast, Australia
Brian J Davis Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN, USA
Thomas N Eade Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
Louise Emmett Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia
Tanya Holt University of Queensland, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
George Hruby Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
David Pryor Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
Thomas P Shakespeare North Coast Cancer Institute, Coffs Harbour, Australia; University of New South Wales Rural Clinical School, Australia
Mark Sidhom Liverpool Hospital Cancer Therapy Centre, Sydney, Australia; University of New South Wales, Australia
Marketa Skala Royal Hobart Hospital, Australia
Kirsty Wiltshire Peter MacCallum Cancer Centre, Melbourne, Australia
John Yaxley University of Queensland, Australia; Royal Brisbane and Women's Hospital, Australia; Wesley Urology Clinic, Brisbane, Australia
Andrew Kneebone Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia

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Vilela RA, Navarro NF, Faria ET, Ferreira EB, Ruzza RZ, Gadia R, Guerra ENS, Reis PEDD. Use of stereotactic body radiation therapy for oligometastatic recurrent prostate cancer: A systematic review. J Med Imaging Radiat Oncol 2018;62:692-706. [DOI: 10.1111/1754-9485.12747] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/14/2018] [Indexed: 12/13/2022]

De Bari B, Fiorentino A, Greto D, Ciammella P, Arcangeli S, Avuzzi B, D'Angelillo RM, Desideri I, Kirienko M, Marchiori D, Massari F, Fundoni C, Franco P, Filippi AR, Alongi F. Prostate cancer as a paradigm of multidisciplinary approach? Highlights from the Italian young radiation oncologist meeting. TUMORI JOURNAL 2018;99:637-49. [DOI: 10.1177/030089161309900601] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]

Biochemical Recurrence After Radiation Therapy. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open

Ponti E, Lancia A, Ost P, Trippa F, Triggiani L, Detti B, Ingrosso G. Exploring All Avenues for Radiotherapy in Oligorecurrent Prostate Cancer Disease Limited to Lymph Nodes: A Systematic Review of the Role of Stereotactic Body Radiotherapy. Eur Urol Focus 2017;3:538-544. [DOI: 10.1016/j.euf.2017.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/18/2017] [Accepted: 07/28/2017] [Indexed: 01/05/2023]

Radiotherapy as metastasis-directed therapy for oligometastatic prostate cancer. Curr Opin Urol 2017;27:587-595. [DOI: 10.1097/mou.0000000000000441] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]

Franzese C, Lopci E, Di Brina L, D'Agostino GR, Navarria P, Mancosu P, Tomatis S, Chiti A, Scorsetti M. 11C-Choline-Pet Guided Stereotactic Body Radiation Therapy for Lymph Node Metastases in Oligometastatic Prostate Cancer. Cancer Invest 2017;35:586-593. [PMID: 28980836 DOI: 10.1080/07357907.2017.1375116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]

Does Choline PET/CT Change the Management of Prostate Cancer Patients With Biochemical Failure? Am J Clin Oncol 2017;40:256-259. [PMID: 25319322 DOI: 10.1097/coc.0000000000000139] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Abstract

PURPOSE

The FDA approved C-11 choline PET/computed tomography (CT) for imaging patients with recurrent prostate cancer in 2012. Subsequently, the 2014 NCCN guidelines have introduced labeled choline PET/CT in the imaging algorithm of patients with suspected recurrent disease. However, there is only scarce data on the impact of labeled choline PET/CT findings on disease management. We hypothesized that labeled-choline PET/CT studies showing local or regional recurrence or distant metastases will have a direct role in selection of appropriate patient management and improve radiation planning in patients with disease that can be controlled using this mode of therapy.

METHODS

This retrospective study was approved by the Tel Aviv Sourasky and Sheba Medical Center's Helsinki ethical review committees. Patient characteristics including age, PSA, stage, prior treatments, and pre-PET choline treatment recommendations based on NCCN guidelines were recorded. Patients with biochemical failure and without evidence of recurrence on physical examination or standard imaging were offered the option of additional imaging with labeled choline PET/CT. Treatment recommendations post-PET/CT were compared with pre-PET/CT ones. Pathologic confirmation was obtained before prostate retreatment. A nonparametric χ test was used to compare the initial and final treatment recommendations following choline PET/CT.

RESULTS

Between June 2010 and January 2014, 34 labeled-choline PET/CT studies were performed on 33 patients with biochemical failure following radical prostatectomy (RP) (n=6), radiation therapy (RT) (n=6), brachytherapy (n=2), RP+salvage prostate fossa RT (n=14), and RP+salvage prostate fossa/lymph node RT (n=6). Median PSA level before imaging was 2 ng/mL (range, 0.16 to 79). Labeled choline PET/CT showed prostate, prostate fossa, or pelvic lymph node increased uptake in 17 studies, remote metastatic disease in 9 studies, and failed to identify the cause for biochemical failure in 7 scans.PET/CT altered treatment approach in 18 of 33 (55%) patients (P=0.05). Sixteen of 27 patients (59%) treated previously with radiation were retreated with RT and delayed or eliminated androgen deprivation therapy: 1 received salvage brachytherapy, 10 received salvage pelvic lymph node or prostate fossa irradiation, 2 brachytherapy failures received salvage prostate and lymph nodes IMRT, and 3 with solitary bone metastasis were treated with radiosurgery. Eleven of 16 patients retreated responded to salvage therapy with a significant PSA response (<0.2 ng/mL), 2 patients had partial biochemical responses, and 3 patients failed. The median duration of response was 500±447 days. Two of 6 patients with no prior RT were referred for salvage prostatic fossa RT: 1 received dose escalation for disease identified in the prostate fossa and another had inclusion of "hot" pelvic lymph nodes in the treatment volume.

CONCLUSIONS

These early results suggest that labeled choline PET/CT imaging performed according to current NCCN guidelines may change management and improve care in prostate cancer patients with biochemical failure by identifying patients for referral for salvage radiation therapy, improving radiation planning, and delaying or avoiding use of androgen deprivation therapy.

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Triggiani L, Alongi F, Buglione M, Detti B, Santoni R, Bruni A, Maranzano E, Lohr F, D'Angelillo R, Magli A, Bonetta A, Mazzola R, Pasinetti N, Francolini G, Ingrosso G, Trippa F, Fersino S, Borghetti P, Ghirardelli P, Magrini SM. Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study. Br J Cancer 2017;116:1520-1525. [PMID: 28449007 PMCID: PMC5518848 DOI: 10.1038/bjc.2017.103] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 02/07/2023] Open

Affiliation(s)

Luca Triggiani Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
Filippo Alongi Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
Michela Buglione Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
Beatrice Detti Department of Radiation Oncology, A.O.U Careggi, University of Florence, Florence, Italy
Riccardo Santoni Department of Radiation Oncology, Policlinico Tor Vergata, University of Rome, Rome, Italy
Alessio Bruni Department of Radiation Oncology, AOU Policlinico Modena, Modena, Italy
Ernesto Maranzano Department of Radiation Oncology, 'S. Maria' Hospital, Terni, Italy
Frank Lohr Department of Radiation Oncology, AOU Policlinico Modena, Modena, Italy
Rolando D'Angelillo Department of Radiation Oncology, Campus Biomedico University, Rome, Italy
Alessandro Magli Department of Radiation Oncology, 'Santa Maria della Misericordia' Hospital, Udine, Italy
Alberto Bonetta Department of Radiation Oncology, Cremona Hospital, Cremona, Italy
Rosario Mazzola Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
Nadia Pasinetti Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
Giulio Francolini Department of Radiation Oncology, A.O.U Careggi, University of Florence, Florence, Italy
Gianluca Ingrosso Department of Radiation Oncology, Policlinico Tor Vergata, University of Rome, Rome, Italy
Fabio Trippa Department of Radiation Oncology, 'S. Maria' Hospital, Terni, Italy
Sergio Fersino Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
Paolo Borghetti Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
Paolo Ghirardelli Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
Stefano Maria Magrini Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy

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Benjamin LC, Tree AC, Dearnaley DP. The Role of Hypofractionated Radiotherapy in Prostate Cancer. Curr Oncol Rep 2017;19:30. [PMID: 28343352 PMCID: PMC5366169 DOI: 10.1007/s11912-017-0584-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]

Kairemo KJA. PET/Computed Tomography for Radiation Therapy Planning of Prostate Cancer. PET Clin 2017;12:257-267. [PMID: 28267458 DOI: 10.1016/j.cpet.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]

Hong JC, Salama JK. The expanding role of stereotactic body radiation therapy in oligometastatic solid tumors: What do we know and where are we going? Cancer Treat Rev 2017;52:22-32. [PMID: 27886588 DOI: 10.1016/j.ctrv.2016.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 02/07/2023]

Bluemel C, Linke F, Herrmann K, Simunovic I, Eiber M, Kestler C, Buck AK, Schirbel A, Bley TA, Wester HJ, Vergho D, Becker A. Impact of ⁶⁸Ga-PSMA PET/CT on salvage radiotherapy planning in patients with prostate cancer and persisting PSA values or biochemical relapse after prostatectomy. EJNMMI Res 2016;6:78. [PMID: 27785766 PMCID: PMC5081978 DOI: 10.1186/s13550-016-0233-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/18/2016] [Indexed: 12/29/2022] Open

A Retrospective Feasibility Study of Salvage Pelvic Nodal Radiation in 6 Patients With Biochemical Failure Following Prostate Fossa Radiation. Am J Clin Oncol 2016;39:479-483. [DOI: 10.1097/coc.0000000000000079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Ost P, Jereczek-Fossa B, Van As N, Zilli T, Tree A, Henderson D, Orecchia R, Casamassima F, Surgo A, Miralbell R, De Meerleer G. Pattern of Progression after Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Nodal Recurrences. Clin Oncol (R Coll Radiol) 2016;28:e115-20. [DOI: 10.1016/j.clon.2016.04.040] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 10/21/2022]

Ricardi U, Badellino S, Filippi AR. Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach. JOURNAL OF RADIATION RESEARCH 2016;57:i58-i68. [PMID: 26962198 PMCID: PMC4990103 DOI: 10.1093/jrr/rrw006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]

Oligometastatic prostate cancer: Metastases-directed therapy? Arab J Urol 2016;14:179-82. [PMID: 27547457 PMCID: PMC4983156 DOI: 10.1016/j.aju.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/04/2016] [Accepted: 06/05/2016] [Indexed: 11/20/2022] Open

Franzese C, Cozzi L, Franceschini D, D'Agostino G, Comito T, De Rose F, Navarria P, Mancosu P, Tomatis S, Fogliata A, Scorsetti M. Role of Stereotactic Body Radiation Therapy with Volumetric-Modulated Arcs and High-Intensity Photon Beams for the Treatment of Abdomino-Pelvic Lymph-Node Metastases. Cancer Invest 2016;34:348-54. [PMID: 27414125 DOI: 10.1080/07357907.2016.1197235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]

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Muldermans JL, Romak LB, Kwon ED, Park SS, Olivier KR. Stereotactic Body Radiation Therapy for Oligometastatic Prostate Cancer. Int J Radiat Oncol Biol Phys 2016;95:696-702. [PMID: 27131082 PMCID: PMC5154616 DOI: 10.1016/j.ijrobp.2016.01.032] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 02/06/2023]

Abstract

PURPOSE

To review outcomes of patients with oligometastatic prostate cancer (PCa) treated with stereotactic body radiation therapy (SBRT) and to identify variables associated with local failure.

METHODS AND MATERIALS

We retrospectively reviewed records of patients treated with SBRT for oligometastatic PCa. Metastasis control (ie, control of the treated lesion, MC), biochemical progression-free survival, distant progression-free survival, and overall survival were estimated with the Kaplan-Meier method.

RESULTS

Sixty-six men with 81 metastatic PCa lesions, 50 of which were castrate-resistant, were included in the analysis. Lesions were in bone (n=74), lymph nodes (n=6), or liver (n=1). Stereotactic body radiation therapy was delivered in 1 fraction to 71 lesions (88%), at a median dose of 16 Gy (range, 16-24 Gy). The remaining lesions received 30 Gy in 3 fractions (n=6) or 50 Gy in 5 fractions (n=4). Median follow-up was 16 months (range, 3-49 months). Estimated MC at 2 years was 82%. Biochemical progression-free survival, distant progression-free survival, and overall survival were 54%, 45%, and 83%, respectively. On multivariate analysis, only the dose of SBRT was significantly associated with MC; lesions treated with 16 Gy had 58% MC, and those treated with ≥18 Gy had 95% MC at 2 years (P≤.001). At 2 years, MC for lesions treated with 18 Gy (n=21) was 88%. No patient treated with ≥18 Gy in a single fraction or with any multifraction regimen had local failure. Six patients (9%) had grade 1 pain flare, and 2 (3%) had grade 2 pain flare. No grade 2 or greater late toxicities were reported.

CONCLUSIONS

Stereotactic body radiation therapy for patients with oligometastatic prostate cancer provided optimal metastasis control and acceptable toxicity with doses ≥18 Gy. Biochemical progression-free survival was 54% at 16 months with the inclusion of SBRT in the treatment regimen. Stereotactic body radiation therapy should be considered in patients with castration-refractory, oligometastatic prostate cancer who have limited options for systemic therapy.

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Ingrosso G, Trippa F, Maranzano E, Carosi A, Ponti E, Arcidiacono F, Draghini L, Di Murro L, Lancia A, Santoni R. Stereotactic body radiotherapy in oligometastatic prostate cancer patients with isolated lymph nodes involvement: a two-institution experience. World J Urol 2016;35:45-49. [PMID: 27233779 DOI: 10.1007/s00345-016-1860-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/18/2016] [Indexed: 12/14/2022] Open

Fodor A, Berardi G, Fiorino C, Picchio M, Busnardo E, Kirienko M, Incerti E, Dell'Oca I, Cozzarini C, Mangili P, Pasetti M, Calandrino R, Gianolli L, Di Muzio NG. Toxicity and efficacy of salvage carbon 11-choline positron emission tomography/computed tomography-guided radiation therapy in patients with lymph node recurrence of prostate cancer. BJU Int 2016;119:406-413. [DOI: 10.1111/bju.13510] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]