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Treatment outcomes of metastasis-directed treatment using 68Ga-PSMA-PET/CT for oligometastatic or oligorecurrent prostate cancer: Turkish Society for Radiation Oncology group study (TROD 09-002)

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Abstract

Purpose

The aim of this study was to evaluate the outcomes of 68Ga prostate-specific membrane antigen (68Ga-PSMA) positron-emission tomography (PET)/CT-based metastasis-directed treatment (MDT) for oligometastatic prostate cancer (PC).

Methods

In this multi-institutional study, clinical data of 176 PC patients with 353 lesions receiving MDT between 2014 and 2019 were retrospectively evaluated. All patients had biopsy proven PC with ≤5 metastases detected with 68Ga-PSMA-PET/CT. MDT was delivered with conventional fractionation or stereotactic body radiotherapy (SBRT) techniques. CTCAE v4.0 was used for acute and RTOG/EORTC Late Radiation Morbidity Scoring Schema was used for late toxicity evaluation.

Results

At the time of MDT, 59 patients (33.5%) had synchronous and 117 patients (66.5%) had metachronous metastases. Median number of metastases was one and the MDT technique was SBRT in 73.3% patients. The 2‑year overall survival (OS) and progression-free survival (PFS) rates were 87.6% and 63.1%, respectively. With a median follow-up of 22.9 months, 9 patients had local recurrence at the irradiated site. The 2‑year local control rate at the treated oligometastatic site per patient was 93.2%. In multivariate analysis, an increased number of oligometastases and untreated primary PC were negative predictors for OS; advanced clinical tumor stage, untreated primary PC, BED3 value of ≤108 Gy, and MDT with conventional fractionation were negative predictors for PFS. No patient experienced grade ≥3 acute toxicity, but one patient had a late grade 3 toxicity of compression fracture after spinal SBRT.

Conclusion

68Ga-PSMA-PET/CT-based MDT is an efficient and safe treatment for oligometastatic PC patients. Proper patient selection might improve treatment outcomes.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Radiation Oncology, Hacettepe University, Ankara, Turkey

    Pervin Hurmuz M.D., Gokhan Ozyigit M.D., Burak Tilki M.D. & Fadıl Akyol M.D.

  2. Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University, Adana, Turkey

    Cem Onal M.D. & Ozan Cem Guler M.D.

  3. Department of Radiation Oncology, Istanbul Bilim University, Istanbul, Turkey

    Sefik Igdem M.D.

  4. Maslak Hospital, Department of Radiation Oncology, Acıbadem MAA University, Istanbul, Turkey

    Banu Atalar M.D. & Teuto Zoto Mustafayev M.D., Ph.D.

  5. Department of Radiation Oncology, Ankara Bilkent City Hospital, Ankara, Turkey

    Haluk Sayan M.D. & Irem Saricanbaz M.D.

  6. Division of Radiation Oncology, Memorial Sisli Hospital, Istanbul, Turkey

    Zuleyha Akgun M.D.

  7. Faculty of Medicine, Department of Radiation Oncology, Uludag University, Bursa, Turkey

    Meral Kurt M.D.

  8. Division of Radiation Oncology, ASM Hospital, Istanbul, Turkey

    Hale Basak Ozkok M.D. & Rashad Rzazade M.D.

  9. Faculty of Medicine, Department of Radiation Oncology, Koc University, Istanbul, Turkey

    Ugur Selek M.D.

  10. Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey

    Ezgi Oymak M.D.

  11. Turkish Society for Radiation Oncology, Istanbul, Turkey

    Gokhan Ozyigit M.D.

Authors
  1. Pervin Hurmuz M.D.
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  2. Cem Onal M.D.
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  9. Hale Basak Ozkok M.D.
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  11. Ezgi Oymak M.D.
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  14. Teuto Zoto Mustafayev M.D., Ph.D.
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  16. Rashad Rzazade M.D.
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Corresponding author

Correspondence to Gokhan Ozyigit M.D..

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Conflict of interest

P. Hurmuz, C. Onal, G. Ozyigit, S. Igdem, B. Atalar, H. Sayan, Z. Akgun, M. Kurt, H.B. Ozkok, U. Selek, E. Oymak, B. Tilki, O.C. Guler, T.Z. Mustafayev, I. Saricanbaz, R. Rzazade, and F. Akyol declare that they have no competing interests.

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Hurmuz, P., Onal, C., Ozyigit, G. et al. Treatment outcomes of metastasis-directed treatment using 68Ga-PSMA-PET/CT for oligometastatic or oligorecurrent prostate cancer: Turkish Society for Radiation Oncology group study (TROD 09-002). Strahlenther Onkol 196, 1034–1043 (2020). https://doi.org/10.1007/s00066-020-01660-6

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