Progression-free Survival Following Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Treatment-naive Recurrence: A Multi-institutional Analysis

2016 ◽  
Vol 69 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Piet Ost ◽  
Barbara Alicja Jereczek-Fossa ◽  
Nicholas Van As ◽  
Thomas Zilli ◽  
Alexander Muacevic ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Stereotactic Body Radiotherapy ◽  
Institutional Analysis ◽  
Progression Free Survival ◽  
Prostate Cancer Treatment ◽  
Free Survival ◽  
Oligometastatic Prostate Cancer ◽  
Treatment Naïve

scholarly journals Stereotactic body radiotherapy (SBRT) in metachronous oligometastatic prostate cancer: a systematic review and meta-analysis on the current prospective evidence

2020 ◽  
Vol 93 (1116) ◽  
pp. 20200496
Author(s):  
Michael Yan ◽  
Nikitha Moideen ◽  
Vanessa Freitas Bratti ◽  
Fabio Ynoe de Moraes
Keyword(s):  
Prostate Cancer ◽  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Local Control Rate ◽  
Free Survival ◽  
Significant Toxicity ◽  
Oligometastatic Prostate Cancer ◽  
Grade 3

Objective: In contrast to traditional views of incurability, patients with oligometastatic disease present with an opportunity for disease eradication with aggressive treatment. There is mounting evidence in support of the role of stereotactic body radiotherapy (SBRT) in oligometastatic prostate cancer (OMPC). Methods: MEDLINE and EMBASE were queried for prospective cohort studies reporting the outcomes of metachronous OMPC treated with SBRT. The primary outcome was overall local control. Secondary outcomes included androgen deprivation therapy-free survival (ADTFS), biochemical recurrence free survival (BCFS), and progression-free survival (PFS). When appropriate, these endpoints were combined in a meta-analysis. Results: We screened 356 abstracts and identified 10 studies to include in our analysis, with a total of 653 patients and 1,111 lesions. The maximum number of lesions included in any single study ranged from 3 to 5. PET-CT staging occurred in 92.4% of all patients. SBRT dose varied, with BED1.5 ranging from 152 to 408. Only one Grade 3 bone toxicity was observed. Meta-analysis reported an overall local control rate of 97% (95% CI, 94–100). Median ADTFS was 24.7 months (95% CI, 20.1–29.2 months). Two-year BCFS, PFS, and ADTFS were 33% (95% CI, 11–55), 39% (95% CI, 24–54), and 52% (95%CI, 41–62), respectively. Patients treated with SBRT were half as likely to experience PSA progression than those on observation when looking at randomized control trial data alone. Conclusion: SBRT appears to be effective in controlling overall disease burden in metachronous OMPC patients and is associated with minimal significant toxicity. The current prospective literature is scarce, and further prospective data are needed to guide treatment recommendations. Advances in knowledge: This study provides a comprehensive summary of the prospective evidence reporting the outcomes of SBRT in the management of OMPC patients. We quantify the rates of local control, biochemical-free recurrence, progression-free survival, and ADT-free survival through meta-analysis.

Recurrence pattern of stereotactic body radiotherapy in oligometastatic prostate cancer: a multi-institutional analysis

2019 ◽  
Vol 196 (3) ◽  
pp. 213-221 ◽  
Author(s):  
Luca Nicosia ◽  
Ciro Franzese ◽  
Rosario Mazzola ◽  
Davide Franceschini ◽  
Michele Rigo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Stereotactic Body Radiotherapy ◽  
Institutional Analysis ◽  
Recurrence Pattern ◽  
Oligometastatic Prostate Cancer

Oligometastatic prostate cancer: An evaluation of stereotactic body radiotherapy (SBRT) as an alternative to palliative androgen deprivation therapy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 229-229
Author(s):  
Daniel Robert Henderson ◽  
Alison Tree ◽  
Helen Taylor ◽  
Vincent Khoo ◽  
Nicholas John Van As
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Stereotactic Body Radiotherapy ◽  
Free Survival ◽  
Choline Pet ◽  
Pet Ct ◽  
Oligometastatic Prostate Cancer

229 Background: Oligometastatic prostate cancer (OPC) can be defined as 1-3 sites of metastasis, typically occurring some years after radical treatment for primary disease. Standard treatment is long-term palliative androgen deprivation therapy (ADT). Although effective, this treatment can have a significant impact on quality of life. We hypothesized that ablative treatment with SBRT may delay disease progression, and therefore the need for palliative ADT. Methods: A single-institution case series 2011-present. Eligible patients had metachronous OPC diagnosed by F-choline PET/CT and were ADT-naïve in the palliative setting. Stereotactic body radiotherapy was given to a dose of 30 Gy in 3 fractions using a robotic radiosurgery system (Cyberknife). ADT-free survival was calculated as the time from completion of treatment for oligometastatic disease to initiation of ADT with palliative intent. Follow up with clinical review and PSA was undertaken at four weeks, then three monthly, with F-choline PET/CT restaging as indicated. Palliative ADT was initiated for metastatic disease not amenable to further SBRT. Results: Twenty one patients received SBRT for ADT-naïve OPC. Median time from primary treatment to oligometastatic relapse was 59.7 months. Median PSA doubling time was 4.1 months. Six patients received a short course (3-6 months) of ADT with SBRT. Sites treated: bone (8) and lymph node (20). At a median follow up of 16.7 months, 81% (17) remained ADT-free. Median ADT-free survival was 28 months (95% CI: 10 - 43 months). All but one patient had a PSA response, with a median reduction of 84%. There were no local failures. Incidence of grade 1 and 2 CTCAE toxicity was 29% (6) and 5% (1), respectively. No toxicity of grade 3 or above was observed. Conclusions: SBRT for OPC is well tolerated. A clinically significant delay in initiation of palliative ADT was observed in patients with ADT-naïve oligometastatic disease. In view of this potential to improve patients’ quality of life, randomised trials against a standard of care are justified.

Stereotactic ablative radiation therapy for the treatment of oligometastatic prostate cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5020-5020 ◽  
Author(s):  
Phuoc T. Tran ◽  
C. Leigh Moyer ◽  
Ryan Phillips ◽  
Noura Radwan ◽  
Ashley Ross ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Outcomes ◽  
Local Treatment ◽  
Progression Free Survival ◽  
Stereotactic Ablative Radiotherapy ◽  
High Dose ◽  
Free Survival ◽  
Local Progression ◽  
Oligometastatic Prostate Cancer

5020 Background: The importance of local treatment in oligometastatic prostate cancer (OPC) is unknown. Stereotactic ablative radiotherapy (SABR) is highly focused, high-dose radiation that is well suited for treatment of oligometastases. Here we report on the safety and preliminary clinical outcomes of SABR in a modern cohort of OPC men. Methods: Eighty four men who satisfied criteria of OPC diagnosed on imaging underwent consolidative SABR were then followed prospectively on our IRB approved registry by our GU multidisciplinary team. We collected demographic, clinical, toxicity and efficacy information. We examined the first 66 men in this preliminary report to allow for a minimum of 4.5 months follow-up. SABR was delivered in 1-5 fractions of 5-18 Gy. Kaplan-Meier method was used to assess local progression-free survival (LPFS), biochemical progression-free survival (bPFS; PSA nadir+2), distant progression free survival (DPFS), ADT-free survival (ADT-FS) and time-to-next intervention (TTNI). Results: Of the 66 OPC patients analyzed, 25 (38%) men presented as synchronous OPC and the remaining 41 had recurrent OPC. Median and mean follow-up was 61 and 66 weeks, respectively. Patient and disease factors as listed in the Table. Crude Grade 1 and 2 acute toxicities were 36% and 11%, respectively, with no Grade > 2 toxicity. SABR was delivered to 134 metastases: 89 bone (66%), 40 nodal (30%) and 5 (4%) visceral metastases. Overall LPFS at 1-year was 92%. The bPFS and DPFS at 1-year were 69% and 69%, respectively. Median TTNI was not reached yet. Of the 18 men with hormone sensitive prostate cancer who had their ADT deferred, 11/18 (56%) remain free of disease following SABR (1-year ADT-FS was 78%) and in 17 castration resistant men, 11 had > 50% PSA declines with 1-year TTNI of 30% with a median of 45 weeks. Conclusions: Consolidative SABRfor OPCis feasible and well tolerated. The preliminary clinical outcomes in our series is limited by heterogeneity and size but our data suggests that this approach is worthy of further prospective study. [Table: see text]

Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence (STOMP): Five-year results of a randomized phase II trial.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 10-10 ◽  
Author(s):  
Piet Ost ◽  
Dries Reynders ◽  
Karel Decaestecker ◽  
Valerie Fonteyne ◽  
Nicolaas Lumen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Phase Ii ◽  
Progression Free Survival ◽  
Hazard Ratio ◽  
Phase Ii Trials ◽  
Curative Intent ◽  
Free Survival ◽  
Randomized Phase Ii ◽  
Oligometastatic Prostate Cancer ◽  
Significant Difference

10 Background: Multiple randomized phase II trials suggest that metastasis-directed therapy (MDT) for oligometastatic prostate cancer (PCa) improves progression-free survival, but the majority of trials lack longer follow-up. We present the updated 5-year results from the STOMP-trial. Methods: In this multicentre, randomised, phase II study, asymptomatic PCa patients were eligible in case of a biochemical recurrence following primary PCa treatment with curative intent and presenting with up to 3 extracranial on choline PET-CT and a serum testosterone levels > 50 ng/ml. Patients were randomly assigned (1:1) to either surveillance or MDT of all detected lesions. Randomisation was balanced dynamically on two factors: PSA doubling time (≤3 vs. > 3 months) and nodal vs non-nodal metastases. The primary endpoint was androgen deprivation therapy (ADT)-free survival. Castrate resistant prostate cancer-free survival (CRPC) was a secondary endpoint. Tests were performed two-sided; p values less than 0.20 were deemed significant. Results: The 5-year ADT-free survival was 8% for the surveillance group and 34% for the MDT group (Figure 1, hazard ratio 0.57 [80% CI: 0.38-0.84], log-rank p = 0.06). There was no significant difference in effect for the different stratification factors (interaction test). The 5-year CRPC-free survival was 53% for the surveillance group and 76% for the MDT group (hazard ratio 0.62 [80% CI: 0.35−1.09]; log−rank p = 0.27). At a median follow for survival of 5.3 years (IQR 4.3-6.3), the 5-year overall survival was 85%, with 6 out of 14 deaths attributed to prostate cancer. Conclusions: The updated STOMP trial outcomes confirm the earlier reported significant difference in ADT free survival in favor of the MDT group compared to surveillance. Prostate-cancer related mortality is low within the first 5 years of diagnosis of oligorecurrent prostate cancer. Clinical trial information: NCT01558427.

scholarly journals [18F]Fluorocholine PET/CT-guided stereotactic body radiotherapy in patients with recurrent oligometastatic prostate cancer

2019 ◽  
Vol 47 (1) ◽  
pp. 185-191 ◽  
Author(s):  
Francesco Pasqualetti ◽  
Marco Panichi ◽  
Martina Sollini ◽  
Aldo Sainato ◽  
Luca Galli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systemic Therapy ◽  
Stereotactic Body Radiotherapy ◽  
Clinical Decision Making ◽  
Cox Regression ◽  
Ct Guided ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Pet Ct ◽  
Oligometastatic Prostate Cancer

Abstract Background In the last years, functional imaging has given a significant contribution to the clinical decision-making of biochemically relapsed prostate cancer (PCa). Hereby, we present a prospective study aiming to validate the role of [18F]Fluoro-Methyl Choline ([18F]FMCH) PET/CT in the selection of PCa patients suitable for stereotactic body radiotherapy (SBRT). Methods Patients with biochemical recurrence limited up to three lesions revealed by [18F]FMCH PET/CT were enrolled in the present study and treated with SBRT on all active lesions. Systemic therapy-free survival since the [18F]FMCH PET/CT was considered as the primary endpoint. Results Forty-six patients were evaluated, and a total of 67 lesions were treated. After a median follow-up of 28.9 months, systemic therapy was started in 30 patients (65.2%) and median systemic therapy-free survival was 39.1 months (95% CI 6.5–68.6); 6, 12, and 24-month ratios were 93.5%, 73.9%, and 63.1%, respectively. At univariate Cox regression analysis, Delta PSA demonstrated an impact on systemic therapy-free survival (p < 0.001). Conclusions Based on our findings, [18F]FMCH PET/CT can identify oligometastatic prostate cancer patients suitable for SBRT, resulting in a systemic therapy-free survival of 39.1 months.

scholarly journals Adding ADT to PSMA-PET/CT-guided SBRT for oligometastatic prostate cancer improves distant progression-free survival

2019 ◽  
Vol 30 ◽  
pp. v342
Author(s):  
C. Mercier ◽  
C. Billiet ◽  
M. Strijbos ◽  
T. Van den Mooter ◽  
F. Vandaele ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Progression Free Survival ◽  
Ct Guided ◽  
Free Survival ◽  
Psma Pet ◽  
Pet Ct ◽  
Oligometastatic Prostate Cancer

scholarly journals Stereotactic body radiotherapy for low-risk prostate cancer: Five-year outcomes.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 94-94
Author(s):  
D. Freeman ◽  
C. R. King
Keyword(s):  
Prostate Cancer ◽  
Stereotactic Body Radiotherapy ◽  
Progression Free Survival ◽  
Low Risk ◽  
Free Survival ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Biochemical Progression ◽  
Grade 3

94 Background: Hypofractionated, stereotactic body radiotherapy (SBRT) is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT. Methods: Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35–36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method) and RTOG toxicity outcomes were assessed. Results: At a median follow-up of 5 years the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%). Acute side effects resolved within 1–3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation. Conclusions: Five-year results of SBRT for localized prostate cancer demonstrate the effectiveness and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are expected to further support this experience. [Table: see text]

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