Salvage Stereotactic Body Radiotherapy for Patients With Limited Prostate Cancer Metastases: Deferring Androgen Deprivation Therapy
Salvage Stereotactic Body Radiotherapy for Patients With Limited Prostate Cancer Metastases: Deferring Androgen Deprivation Therapy
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DOI：
10.1016/j.clgc.2012.08.003
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发表时间：
2013-03-01
影响因子：
3.2
通讯作者：
Ost, Piet
中科院分区：
文献类型：
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作者：
Berkovic, Patrick;De Meerleer, Gert;Ost, Piet
患有转移性前列腺癌的患者统一采用去势（手术或药物）治疗，这与许多副作用相关，如性功能障碍、疲劳、骨质疏松症、代谢综合征等。这项包括24名患有局限性骨或淋巴结前列腺癌（PCa）转移的患者的单臂研究表明，重复挽救性立体定向体部放疗耐受性良好，并且推迟了开始去势治疗的必要性。背景：我们研究了寡转移性疾病的重复立体定向体部放疗（SBRT）是否能够推迟低转移性疾病患者姑息性雄激素剥夺治疗（ADT）的开始。骨体积和淋巴结转移。患者和方法：在局部根治性治疗后生化复发后，经正电子发射断层扫描诊断为最多3个同步转移（骨和/或淋巴结）的患者接受（重复）SBRT治疗，剂量为50戈伊，分10次进行。无雄激素剥夺治疗生存期（ADT-FS）定义为SBRT第一天与ADT开始之间的时间间隔，是主要终点。如果在随访期间检测到超过3个转移灶，即使患者仍然无症状或在没有转移灶的情况下前列腺特异性抗原升高超过50 ng/mL，也会启动ADT。次要终点是局部控制、临床无进展生存期和毒性。使用不良事件通用术语标准对毒性进行评分。结果：我们治疗了24例患者，中位随访时间为24个月。10例患者开始ADT治疗，中位ADT-FS为38个月。2年局部控制和临床无进展生存率分别为100%和42%。分别有11例和3例患者需要第二次和第三次挽救治疗异时性低容量转移性疾病。未观察到3级毒性。结论：重复挽救性SBRT是可行的，耐受性良好，并推迟姑息性ADT，中位时间为38个月，在有限的骨或淋巴结PCa转移患者中。Clinical Genitourinary Cancer，Vol. 11，No. 1，27-32（C）2013 Elsevier Inc. All rights reserved.
Patients with metastatic prostate cancer are uniformly treated with castration (surgically or medically), which is associated with numerous side effects such as sexual dysfunction, fatigue, osteoporosis, metabolic syndrome, and others. This single-arm study including 24 patients with limited bone or lymph node prostate cancer (PCa) metastases shows that repeated salvage stereotactic body radiotherapy is well tolerated and defers the necessity to start castration treatment.Background: We investigated whether repeated stereotactic body radiotherapy (SBRT) of oligometastatic disease is able to defer the initiation of palliative androgen deprivation therapy (ADT) in patients with low-volume bone and lymph node metastases. Patients and Methods: Patients with up to 3 synchronous metastases (bone and/or lymph nodes) diagnosed on positron emission tomography, following biochemical recurrence after local curative treatment, were treated with (repeated) SBRT to a dose of 50 Gy in 10 fractions. Androgen deprivation therapy-free survival (ADT-FS) defined as the time interval between the first day of SBRT and the initiation of ADT was the primary end point. ADT was initiated if more than 3 metastases were detected during follow-up even when patients were still asymptomatic or in case of a prostate specific antigen elevation above 50 ng/mL in the absence of metastases. Secondary end points were local control, clinical progression-free survival, and toxicity. Toxicity was scored using the Common Terminology Criteria for Adverse Events. Results: We treated 24 patients with a median follow-up of 24 months. Ten patients started with ADT resulting in a median ADT-FS of 38 months. The 2-year local control and clinical progression-free survival was 100% and 42%, respectively. Eleven and 3 patients, respectively, required a second and third salvage treatment for metachronous low-volume metastatic disease. No grade 3 toxicity was observed. Conclusion: Repeated salvage SBRT is feasible, well tolerated and defers palliative ADT with a median of 38 months in patients with limited bone or lymph node PCa metastases. Clinical Genitourinary Cancer, Vol. 11, No. 1, 27-32 (C) 2013 Elsevier Inc. All rights reserved.