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Predictive factors for survival outcomes of oligometastatic prostate cancer patients treated with metastases-directed therapy: a recursive partitioning-based analysis

  • Original Article – Cancer Research
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Abstract

Purpose

The aim of the present study was to provide predictive factors for survival outcomes of oligometastatic prostate cancer (PC) patients treated with stereotactic body radiation therapy (SBRT) as a metastases-directed therapy (MDT).

Methods

In this cohort study, endpoints included overall survival (OS), progression-free survival (PFS), distant progression-free survival (DFS) and local control of treated metastases (LC). The binary classification tree approach with recursive partitioning analysis (RPA) was applied to stratify the patients into risk groups based on OS, PFS and DPFS; for each endpoint, disease-free interval (DFI) was calculated. We included patients with synchronous or metachronous metastases from prostate adenocarcinoma treated with SBRT.

Results

119 Metastases were treated with SBRT in 92 patients. Median follow-up was 22.2 months. Rates of OS at 1 and 3 years were 96.9% and 88.0%, while DPFS was 51.9% and 20.9%. Recursive partitioning analysis identified three prognostic classes for OS: Class 1: castration-sensitive patients (3 years OS 95%); Class 2: castration-resistant patients with low-intermediate risk NCCN disease (3 years OS 88.8%); Class 3: castration-resistant patients with high-risk NCCN disease (3 years OS 76.9%). Regarding DPFS, RPA divided patients into two classes, according to a cutoff value of DFI of 34 months (3 years PFS of 28.7% vs 5.8%). Three classes were identified for DPFS: Class 1: DFI < 34 months (3 years DPFS 9.1%); Class 2: DFI > 34 months and high-risk NCCN PC (3 years DPFS 21%); Class 3: DFI > 34 months and low-intermediate risk NCCN disease (3 years DPFS 60.2%).

Conclusion

Oligometastatic PC represents nowadays a setting of particular interest in which local ablative therapies play a decisive role. In the present study, we recognized the importance of DFI, together with NCCN class risk, to predict the risk of new metastases after SBRT in oligometastatic PC.

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References

  • Breiman L, Friedman J, Olshen R et al (1984) Classification and regression trees. Routledge, Abingdon

    Google Scholar 

  • Castellucci P, Fuccio C, Fanti S (2010) Reply: influence of trigger PSA and PSA kinetics on 11C-Choline PET/CT detection rate in patients with biochemical relapse after radical prostatectomy. J Nucl Med 51:499–500

    Article  Google Scholar 

  • De Bruycker A, Lambert B, Claeys T et al (2017) Prevalence and prognosis of low-volume, oligorecurrent, hormone-sensitive prostate cancer amenable to lesion ablative therapy. BJU Int 120:815–821

    Article  CAS  PubMed  Google Scholar 

  • Decaestecker K, De Meerleer G, Lambert B (2014) Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence. Radiat Oncol 9(1):135

    Article  PubMed  PubMed Central  Google Scholar 

  • Ferlay J, Colombet M, Soeriomataram I et al (2019) Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 144(8):1941–1953

    Article  CAS  Google Scholar 

  • Fizazi K, Tran N, Fein L et al (2017) Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med 377:352–360

    Article  CAS  PubMed  Google Scholar 

  • Franzese C, Zucali PA et al (2018) The efficacy of Stereotactic body radiation therapy and the impact of systemic treatments in oligometastatic patients from prostate cancer. Cancer Med 7:4379–4386

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Häggman M, Salo JO, Andersson S-O et al (2002) A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med 347:781–789

    Article  PubMed  Google Scholar 

  • Hamdy FC, Donovan JL, Lane JA et al (2016) 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 375(15):1415–1424

    Article  PubMed  Google Scholar 

  • Hayakawa K, Yamashita H, Niibe Y et al (2012) Stereotactic body radiotherapy for metastatic lung cancer as oligo-recurrence: an analysis of 42 cases. Pulm Med 2012:1–5

    Google Scholar 

  • Hellman S, Weichselbaum RR (1995) Oligometastases. J Clin Oncol 1995:8–10

    Article  Google Scholar 

  • Hong JC, Ayala-Peacock DN, Lee J et al (2018) Classification for long-term survival in oligometastatic patients treated with ablative radiotherapy: a multi-institutional pooled analysis. PLoS ONE 13:e0195149

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ingrosso G, Trippa F, Maranzano E et al (2017) Stereotactic body radiotherapy in oligometastatic prostate cancer patients with isolated lymph nodes involvement: a two-institution experience. World J Urol 35:45–49

    Article  CAS  PubMed  Google Scholar 

  • Inoue T, Katoh N, Onimaru R et al (2012) Clinical outcomes of stereotactic body radiotherapy for patients with lung tumors in the state of oligo-recurrence. Pulm Med. https://doi.org/10.1155/2012/369820

  • Lund J-Å, Angelsen A, Fransson P et al (2008) Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet 373:301–308

    PubMed  Google Scholar 

  • Muacevic A, Kufeld M, Rist C et al (2013) Safety and feasibility of image-guided robotic radiosurgery for patients with limited bone metastases of prostate cancer. Urol Oncol Semin Org Investig 31:455–460

    Google Scholar 

  • Ost P, Bossi A, Decaestecker K, De Meerleer G, Giannarini GKR (2015) Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol 67(5):852–863

    Article  PubMed  Google Scholar 

  • Ost P, Jereczek-Fossa BA, Van AN et al (2016) Progression-free survival following stereotactic body radiotherapy for oligometastatic prostate cancer treatment-naive recurrence: a multi-institutional analysis. Eur Urol 69:9–12

    Article  PubMed  Google Scholar 

  • Ost P, Reynders D, Decaestecker K et al (2017) Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence: a prospective, randomized, multicenter phase II trial. J Clin Oncol 36(5):446–453

    Article  PubMed  Google Scholar 

  • Park C, Papiez LZS et al (2008) Universal survival curve and single fraction equivalent dose: useful tools in understanding potency of ablative radiotherapy: in Regard to Parks et al. (Int J Radiat Oncol Biol Phys 2008;70:847–852). Int J Radiat Oncol Biol Phys 70:847–852

    Article  PubMed  Google Scholar 

  • Ploussard G, Staerman F, Pierrevelcin J et al (2013) Predictive factors of oncologic outcomes in patients who do not achieve undetectable prostate specific antigen after radical prostatectomy. J Urol 190:1750–1756

    Article  PubMed  Google Scholar 

  • Rybalov M, Breeuwsma AJ, Leliveld AM et al (2013) Impact of total PSA, PSA doubling time and PSA velocity on detection rates of 11C-Choline positron emission tomography in recurrent prostate cancer. World J Urol 31:319–323

    Article  CAS  PubMed  Google Scholar 

  • Schick U, Jorcano S, Nouet P et al (2013) Androgen deprivation and high-dose radiotherapy for oligometastatic prostate cancer patients with less than five regional and/or distant metastases Androgen deprivation and high-dose radiotherapy for regional and/or distant metastases. Acta Oncol 52(8):1622–1628

    Article  CAS  PubMed  Google Scholar 

  • Sweeney CJ, Chen Y-H, Carducci M et al (2015) Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med 373:737–746

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tran S, Jorcano S, Falco T, Lamanna G, Miralbell RZT (2018) Oligorecurrent nodal prostate cancer: long-term results of an elective nodal irradiation approach. Am J Clin Oncol 41(10):960–962

    Article  PubMed  Google Scholar 

  • Triggiani L, Alongi F, Buglione M et al (2017) Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study. Br J Cancer 116:1520–1525

    Article  PubMed  PubMed Central  Google Scholar 

  • Triggiani L, Mazzola R, Magrini SM et al (2019) Metastasis-directed stereotactic radiotherapy for oligoprogressive castration-resistant prostate cancer: a multicenter study. World J Urol. https://doi.org/10.1007/s00345-019-02717-7

  • Yamashita H, Niibe Y, Yamamoto T et al (2016) Lung stereotactic radiotherapy for oligometastases: comparison of oligo-recurrence and sync-oligometastases. Jpn J Clin Oncol 46:687–691

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, Milan, Rozzano, Italy

    Ciro Franzese, Lucia Di Brina, Giuseppe D’Agostino, Davide Franceschini, Tiziana Comito, Fiorenza De Rose, Angelo Tozzi, Pierina Navarria & Marta Scorsetti

  2. Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy

    Ciro Franzese & Marta Scorsetti

Authors
  1. Ciro Franzese
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  2. Lucia Di Brina
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  3. Giuseppe D’Agostino
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  4. Davide Franceschini
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  5. Tiziana Comito
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  6. Fiorenza De Rose
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  7. Angelo Tozzi
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  8. Pierina Navarria
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  9. Marta Scorsetti
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Correspondence to Ciro Franzese.

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Informed consent was obtained from all individual participants included in the study.

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Franzese, C., Di Brina, L., D’Agostino, G. et al. Predictive factors for survival outcomes of oligometastatic prostate cancer patients treated with metastases-directed therapy: a recursive partitioning-based analysis. J Cancer Res Clin Oncol 145, 2469–2479 (2019). https://doi.org/10.1007/s00432-019-03007-w

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  • DOI: https://doi.org/10.1007/s00432-019-03007-w

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