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Outcome of loco-regional radiotherapy in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate

  • Berna Akkus Yildirim
  • Cem OnalEmail author
  • Fatih Kose
  • Ezgi Oymak
  • Ali Murat Sedef
  • Ali Ayberk Besen
  • Sercan Aksoy
  • Ozan Cem Guler
  • Ahmet Taner Sumbul
  • Sadık Muallaoglu
  • Huseyin Mertsoylu
  • Gokhan Ozyigit
Original Article
  • 54 Downloads

Abstract

Purpose

To evaluate the potential benefit of curative radiotherapy (RT) to the primary tumor in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone.

Materials and methods

The clinical parameters of 106 mCRPC patients treated with abiraterone were retrospectively evaluated. Patients were either oligometastatic (≤5 metastases) at diagnosis or became oligometastatic after the systemic treatment was analyzed. Local RT to the primary tumor and pelvic lymphatics was delivered in 44 patients (41%), and 62 patients (59%) did not have RT to the primary tumor. After propensity match analysis, a total of 92 patients were analyzed.

Resultsn

Median follow-up time was 14.2 months (range: 2.3–54.9 months). Median overall survival (OS) was higher in patients treated with local RT to the primary tumor than in those treated without local RT with borderline significance (24.1 vs. 21.4 months; p = 0.08). Local RT to the prostate and pelvic lymphatics significantly diminished the local recurrence rate (16 patients, 31% vs. 2 patients, 5%; p = 0.003). In multivariate analysis, the prostate specific antigen (PSA) response ≥50% of the baseline obtained 3 weeks after abiraterone therapy was the only significant prognostic factor for better OS and progression-free survival (PFS). Patients treated with primary RT to the prostate had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT.

Conclusions

Local prostate RT significantly improved OS and local control in mCRPC patients treated with abiraterone. The patients treated with primary RT had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT.

Keywords

Prostate Survival Local recurrence Hormonotherapy Metastasis 

Ergebnisse der lokoregionalen Strahlentherapie bei metastatischen kastrationsresistenten und mit Abirateronacetat behandelten Prostakarzinompatienten

Zusammenfassung

Ziel

Bewertung des potenziellen Nutzens der kurativen Strahlentherapie (RT) für den Primärtumor bei Patienten mit metastasiertem kastrationsresistentem Prostatakrebs (mCRPC), die mit Abirateron behandelt werden.

Material und Methoden

Die klinischen Parameter von 106 mit Abirateron behandelten mCRPC-Patienten wurden retrospektiv bewertet. Die Patienten waren bei der Diagnose entweder oligometastatisch (≤5 Metastasen) oder wurden nach Analyse der systemischen Behandlung oligometastatisch. Eine lokale RT für Primärtumor und Beckenlymphknoten bekamen 44 Patienten (41%), 62 Patienten (59%) hatten keine RT des Primärtumors. Nach der Propensity-Match-Analyse wurden insgesamt 92 Patienten analysiert.

Ergebnisse

Die mediane Nachbeobachtungszeit betrug 14,2 Monate (Spanne 2,3–54,9 Monate). Das mediane Gesamtüberleben (OS) war bei den mit lokaler RT behandelten Patienten gegenüber dem Primärtumor höher als bei denjenigen ohne lokale RT, mit grenzwertiger Signifikanz (24,1 vs. 21,4 Monate; p = 0,08). Die lokale RT für die Prostata- und Beckenlymphatika verringerte signifikant die lokale Rezidivrate (16 Patienten, 31% vs. 2 Patienten, 5%; p = 0,003). In der multivariaten Analyse war die 3 Wochen nach Abiraterontherapie ermittelte PSA-Antwort ≥50 des Ausgangswerts der einzige signifikante Prognosefaktor für ein besseres OS und progressionsfreies Überleben (PFS). Patienten, die mit primärer Prostata-RT behandelt wurden, zeigten eine signifikant geringere Progression unter Abirateron und eine längere Abirateron-Periode als Patienten ohne lokale Prostata-RT.

Schlussfolgerung

Die lokale Prostata-RT verbesserte das OS und die lokale Kontrolle bei mit Abirateron behandelten mCRPC-Patienten signifikant. Die mit primärer RT behandelten Patienten hatten unter Abirateron eine deutlich geringere Progression und eine längere Abirateron-Periode als Patienten, die ohne lokale Prostata-RT behandelt wurden.

Schlüsselwörter

Prostata Überleben Local Rezidiv Hormonotherapy Metastasierung 

Notes

Conflict of interest

B.A. Yildirim, C. Onal, F. Kose, E. Oymak, A.M. Sedef, A.A. Besen, S. Aksoy, O.C. Guler, A.T. Sumbul, S. Muallaoglu, H. Mertsoylu, and G. Ozyigit declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Berna Akkus Yildirim
    • 1
  • Cem Onal
    • 1
    Email author
  • Fatih Kose
    • 2
  • Ezgi Oymak
    • 3
  • Ali Murat Sedef
    • 4
  • Ali Ayberk Besen
    • 2
  • Sercan Aksoy
    • 5
  • Ozan Cem Guler
    • 1
  • Ahmet Taner Sumbul
    • 2
  • Sadık Muallaoglu
    • 6
  • Huseyin Mertsoylu
    • 2
  • Gokhan Ozyigit
    • 6
  1. 1.Department of Radiation Oncology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment CentreBaskent UniversityAdanaTurkey
  2. 2.Division of Medical Oncology, Faculty of MedicineBaskent UniversityAdanaTurkey
  3. 3.Division of Radiation OncologyIskenderun Gelisim HospitalHatayTurkey
  4. 4.Division of Medical OncologyAdana City HospitalAdanaTurkey
  5. 5.Division of Medical Oncology, Faculty of MedicineHacettepe UniversityAnkaraTurkey
  6. 6.Department of Radiation Oncology, Faculty of MedicineHacettepe UniversityAnkaraTurkey

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