Oligometastases in prostate cancer: Ablative treatment

Table 1 Summary of selected publications reporting stereotactic body radiation therapy for mixed and bones oligometastatic prostate cancer

Ref.	Study type	No. patients/lesions	No. of metastases	Imaging method	Site of metastases	SBRT schedules	LC	PFS
Mixed
Jereczek-Fossa et al[56]	R	34/38	Single pelvic LN and/or single distant lesion	CT, BS, Choline PET	Bone, LN, local recurrence	30-36 Gy/3-5 fr	88% (16.9 mo)	42.6% (30 mo)
Ahmed et al[49]	P	17/21	≤ 5	Choline PET/CT, MRI, CT	Bone, LN, Liver	Median dose 20 Gy (8-24 Gy/1-3 fr), 50 Gy/5 fr (LN), 60 Gy/3 fr (Liver)	100% (6 mo)	74% (6 mo), 40% (1 yr)
Berkovic et al[45]	R	24/29	≤ 3	BS, 18F-FDG PET/TC, Choline PET/TC	Bone, LN	Median dose 50 Gy (40-50)/8-10 fr	100% (2 yr)	72% (1 yr), 42% (2 yr)
Decaestecker et al[34]	P	50/70	≤ 3	18F-FDG PET/TC, Choline PET/TC	Bone, LN, Viscera	50 Gy/10 fr, 30 Gy/3 fr	100% (2 yr)	64% (1 yr), 35% (2 yr)
Pasqualetti et al[57]	P	29/45	≤ 3	Choline PET/CT	Bone, LN	24 Gy/1 fr, 27 Gy/3 fr	Median 11.5 mo	NR
Muldermans et al[30]	R	66/81	< 5	Choline PET/CT, MRI, CT, BS	Bone, LN, Liver	Median dose 16 Gy (16-24)/1 fr, 30 Gy/3 fr, 50 Gy/5 fr	82% (2 yr)	45% (2 yr)
Bouman-Wammes et al[48]	R	43/54	≤ 4	Choline PET/CT	Bone, LN	30 Gy/3 fr, 45 Gy/3 fr, 35 Gy/5 fr	NR	Median 31.5 mo
Triggiani et al[47]	R	OR: 100/139, OP: 41/70	≤ 3	OR: Choline PET, CT and BS, OP: Choline PET, CT/scintigraphy	Bone, LN	BED 116 (80–216.6) Gy	OR: 92.8% (2 yr), OP: 90.2% (2 yr)	OR: 43% (2 yr), OP: 22% (2 yr)
Pasqualetti et al[46]	P	51/78	≤ 5	Choline PET/CT	Bone, LN	24 Gy/1 fr, 27 Gy/3 fr	98.7% (1 yr), 97.4% (2 yr)	NR
Ost et al[20] (STOMP)	P	Surveillance: 31/65, MDT: 31/51	≤ 3	Choline PET/CT	Extracranial	N = 25 SBRT 30 Gy/3 fr	Median FU (3 yr), MDT: 100%, Surveillance: 19.3%	NR
Siva et al[26] (POPSTART)	P	33 /50	≤ 3	CT/BS /18F-NaF PET	Bone, LN	20 Gy/1 fr	97% (1 yr), 93% (2 yr)	58% (1 yr), 39% (2 yr)
Conde et al[50]	P	67 (100)	≤ 4	Choline PET/CT, NMR Diffusion	Bone, LN	45 Gy/6 fr, 30 Gy/3 fr	100% (Median FU 9 mo)	Median 21 mo, OR: 22.9 mo, OP: 8.7 mo
Bone
Muacevic et al[31]	P	40/64	≤ 2	Choline PET/CT	Bone	Mean dose 20.2 Gy (16.5-22 Gy)/1 fr	95.5% (2 yr)	NR
Habl et al[58]	R	15/20	≤ 5	Choline PET/CT, 68Ga-PSMA-PET	Bone	25-35 Gy/5 fr	100% (2 yr)	Median 7.3 mo
Fanetti et al[59]	R	55/77	≤ 5	Choline-PET/CT, MRI, CT, 68Ga-PSMA-PET/CT	Bone	24 Gy/3 fr (+ frequent)	83% (1 yr)	56% (1 yr)

BED: Biologically effective dose; BS: Bone scan; CT: Computed tomography; 18F-FDG: [18F]-fluorodeoxyglucose; 68Ga-PSMA: 68-Ga-Prostate-Specific Membrane Antigen; LC: Local control; LN: Lymph node; MDT: Metastasis-directed therapy; MRI: Magnetic resonance imaging; 18F-NaF: 18F Sodium Fluoride; NMR: Nuclear magnetic resonance; NR: Not reported; OP: Oligoprogressive; OR: Oligorrecurrent; PET/CT: Positron emission tomography with coregistered computed tomography; P: Prospective; PFS: Progression free survival; R: Retrospective.

Table 2 Summary of selected publications reporting stereotactic body radiation therapy for lymph nodes oligometastatic prostate cancer

Ref.	Study type	No. Patients / lesions	No. of metastases	Imaging method	Site of metastases	SBRT schedules	LC	PFS
Lymph node
Casamassima et al[33]	R	25/25	NR	Cholina PET/CT	LN	N = 18: 30 Gy/3 fr	90% (3 yr)	Median 24 mo
Detti et al[36]	R	30/39	NR	Cholina PET/CT	LN	24-36 Gy/1-5 fr	100% (1 yr)	NR
Ponti et al[60]	R	16/18	≤ 2	Cholina PET/CT	LN	12-35 Gy/1-5 fr	94% (2 yr)	NR
Ost et al[29]	R	72/89	≤ 3	18F-FDG, Cholina PET/CT,MRI	LN	At least 5 Gy/fr with BED at least 80 Gy	95.8% (3 yr)	Median 21 mo 34% (3 yr) 13% (5 yr)
Ingrosso et al[61]	R	40/47	NR	Cholina PET/CT	LN	35-40 Gy/5 fr (+ frequent)	98% (mean FU 30 mo)	NR
Jereczek-Fossa et al[62]	R	94/124	≤ 5	Cholina PET/CT/CT/MRI	LN	24-30 Gy/3 fr (+ frequent)	84% (2 yr)	30% (2 yr)

BED: Biologically effective dose; CT: Computed tomography; 18F-FDG: [18F]-fluorodeoxyglucose; LC: Local control; LN: Lymph node; MRI: Magnetic resonance imaging; NR: Not reported; PET/CT: Positron emission tomography with coregistered computed tomography; PFS: Progression free survival; R: Retrospective; SBRT: Stereotactic body radiation therapy.

Table 3 Summary of clinical trials investigating treatment with stereotactic body radiation therapy in oligometastatic prostate cancer

Study	Study type	Type of patient	No. of metastases	Site of metastases	Intervention	Primary endpoint
NCT02680587 Sidney, Kimmel Comprehensive Cancer Center (ORIOLE)[51]	Phase II	HS	≤ 3	Bone or soft tissue	Observation vs SBRT	Time to progression (Time Frame: 6 mo)
NCT02759783 Royal Marsden Hospital (CORE)[53]	Phase II/III	HS/CR	≤ 3	Extracranial	Standard of Care vs SBRT	Progression Free Survival (Time Frame: 60 mo post treatment)
NCT03569241 PEACE V (STORM) Ghent[54]	Phase II	HS	≤ 3	Pelvic LN	MDT (salvage lymph node dissection or SBRT) vs MDT + WPRT. ADT (6 mo in the two arms)	Metastases-free survival (Time Frame: 2 yr)
NCT02685397 PCS IX[55]	Phase II/III	CR	≤ 4	Any location excluding brain and liver metastasis	LHRH agonist + Enzalutamide vs LHRH agonist + Enzalutamide + SBRT	Radiographic Progression-free Survival (Time Frame: 5 yr)
NCT03361735 City of Hope Medical Center[63]	Phase II	HS	≤ 4	Bone. One lung lesion < 2 cm allowed	ADT + SBRT + Radium Ra223 dichloride	Time to treatment failure (Time Frame: Assessed up to 5 yr)
NCT01818986 Southwestern Medical Center Texas[64]	Phase II	CR	Any number of metastatic site are allowed. However, only up to six sites will be selected for SBRT	Any location except brain metastasis	Sipuleucel-T and SBRT	Time to progression (Time Frame: 4 yr)
NCT02816983 Mayo Clinic Rochester[65]	Phase II	CR	≤ 3	Any location	SBRT	PSA-progression free survival (Time Frame: 1 yr) Overall Survival (Time Frame: 2 yr)
NCT02192788 GICOR Castellon[66]	Phase II	HS/CR	≤ 4	Bone or LN	SBRT	No. of patients without disease progression (Time Frame: 5 yr)

ADT: Androgen deprivation therapy; CR: Castration resistant; HS: Hormone-sensitive; LHRH: Luteinizing hormone-releasing hormone; LN: Lymph node; MDT: Metastasis-directed therapy; PSA: Prostate-specific antigen; SBRT: Stereotactic body radiation therapy; WPRT: Whole pelvic radiotherapy.