Metastasis-directed Therapy Prolongs Efficacy of Systemic Therapy and Improves Clinical Outcomes in Oligoprogressive Castration-resistant Prostate Cancer.
Metastasis-directed Therapy Prolongs Efficacy of Systemic Therapy and Improves Clinical Outcomes in Oligoprogressive Castration-resistant Prostate Cancer.
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转移导向治疗延长了少进展性去势抵抗性前列腺癌的全身治疗效果并改善了临床结果。
DOI：
10.1016/j.euo.2020.05.004
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发表时间：
2021-06
影响因子：
8.2
通讯作者：
Stish BJ
中科院分区：
文献类型：
--
作者：
Deek MP;Taparra K;Phillips R;Velho PI;Gao RW;Deville C;Song DY;Greco S;Carducci M;Eisenberger M;DeWeese TL;Denmeade S;Pienta K;Paller CJ;Antonarakis ES;Olivier KR;Park SS;Tran PT;Stish BJ
去势抵抗性前列腺癌 (CRPC) 的现有疗法带来的生存优势微乎其微；因此，人们对针对寡转移或寡进行性疾病的转移定向治疗（MDT）以改善预后感兴趣。在这里，我们描述了立体定向消融放射治疗 (SABR) 治疗少进展性 CRPC 的结果。报告使用 SABR 进行 MDT 治疗的少进展性 CRPC 的结果。对少进行性 CRPC 患者进行了回顾性评估，并报告了 MDT 后的结果。此外，还与仅改变全身治疗的少进展型 CRPC 的结果进行了比较。 SABR 至寡进行性病变。感兴趣的结果是前列腺特异性抗原（PSA）失败的时间、下次干预的时间（TTNI）、无远处转移生存期（DMFS）和总生存期。采用Kaplan-Meier法进行生存分析，并进行单变量分析和多变量分析(MVA)。总共包括 68 名患者。 MDT 后，PSA 复发的中位时间、TTNI 和 DMFS 分别为 9.7、15.6 和 10.8 个月。总共治疗了 112 个病灶，12 个月和 24 个月的局部失败累积发生率分别为 2.1% 和 13.8%。单变量分析中与局部复发风险相关的因素是年龄（风险比[HR] 1.07，p = 0.03）和格里森分级组（HR 2.20，p = 0.07）。与单独改变全身治疗（n = 52）相比，MDT（n = 31）与PSA失败的中位时间改善相关（9.7 vs 4.2个月，p = 0.066）），TTNI（14.9 vs 8.8个月，p = 0.025）和DMFS（12.7 vs 8.9个月，p = 0.045），并且与MVA结果的改善相关。在少进行性 CRPC 患者的回顾性队列中，与单独改变全身治疗相比，MDT 与良好的预后和改善的癌症控制相关。需要未来的前瞻性试验来证实这些发现。在本报告中，我们回顾性分析了接受放射治疗的进展性病变的少进行性去势抵抗性前列腺癌患者的结果。我们的结果表明，用放射疗法治疗这些病变可以导致持续的无病生存期，并且除了疾病进展时的全身治疗外，还可能增加益处。这些结果需要在前瞻性试验中得到验证，以确定放射治疗与转移性去势抵抗性前列腺癌的最佳整合。
Available therapies for castrate-resistant prostate cancer (CRPC) confer minimal survival advantage; thus, there is interest in metastasis-directed therapy (MDT) for oligometastatic or oligoprogressive disease to improve outcomes. Here, we describe outcomes of oligoprogressive CRPC treated with stereotactic ablative radiotherapy (SABR). To report outcomes of oligoprogressive CRPC treated with MDT using SABR. Patients with oligoprogressive CRPC were retrospectively evaluated, and outcomes following MDT were reported. Outcomes were additionally compared with oligoprogressive CRPC treated with change in systemic therapy alone. SABR to oligoprogressive lesions. Outcomes of interest were time to prostate-specific antigen (PSA) failure, time to next intervention (TTNI), distant metastasis-free survival (DMFS), and overall survival. Survival analysis was performed using the Kaplan-Meier method, and univariable analysis and multivariable analysis (MVA) were performed. A total of 68 patients were included. After MDT, median time to PSA recurrence, TTNI, and DMFS were 9.7, 15.6, and 10.8 months, respectively. A total of 112 lesions were treated, and the cumulative incidences of local failure at 12 and 24 months were 2.1% and 13.8%, respectively. Factors associated with the risk of local recurrence on univariable analysis were age (hazard ratio [HR] 1.07, p = 0.03) and Gleason grade group (HR 2.20, p = 0.07). Compared with change in systemic therapy alone (n = 52), MDT (n = 31) was associated with improved median time to PSA failure (9.7 vs 4.2 months, p = 0.066)), TTNI (14.9 vs 8.8 months, p = 0.025), and DMFS (12.7 vs 8.9 months, p = 0.045), and remained associated with improved outcomes on MVA. In a retrospective cohort of oligoprogressive CRPC patients, MDT was associated with favorable outcomes and improved cancer control as compared with change in systemic treatment alone. Future prospective trials are needed to confirm these findings. In this report, we retrospectively analyzed outcomes of patients with oligoprogressive castrate-resistant prostate cancer treated with radiation therapy to progressing lesions. Our results suggest that treatment of these lesions with radiation therapy can result in sustained periods of disease-free survival and might add benefit in addition to systemic therapy at the time of progression. These results need to be verified in a prospective trial to identify the optimal integration of radiation therapy into metastatic castrate-resistant prostate cancer.
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影响因子：
45.3
作者：
Gomez, Daniel R.;Tang, Chad;Heymach, John, V
通讯作者：
Heymach, John, V
影响因子：
158.5
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Parker, C.;Nilsson, S.;Sartor, O.
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Sartor, O.
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Rathkopf, Dana E.
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158.5
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Scher, Howard I.;Fizazi, Karim;de Bono, Johann S.
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de Bono, Johann S.
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158.5
作者：
Kantoff, Philip W.;Higano, Celestia S.;Young, J.
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Young, J.