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Recurrence pattern of stereotactic body radiotherapy in oligometastatic prostate cancer: a multi-institutional analysis

  • Luca Nicosia
  • Ciro Franzese
  • Rosario Mazzola
  • Davide Franceschini
  • Michele Rigo
  • Giuseppe D’agostino
  • Stefanie Corradini
  • Filippo AlongiEmail author
  • Marta Scorsetti
Original Article

Abstract

Purpose

For patients with oligometastatic/oligorecurrent/oligoprogressive lymph node metastases from PCa, metastases-directed therapy is an emerging strategy. The aim of this retrospective study was to evaluate the oncological outcome and pattern of recurrence in patients treated with stereotactic body radiation therapy (SBRT) to lymph node metastases.

Methods

In this multi-institutional analysis, patients with a maximum of five lymph node metastases from PCa treated with SBRT were included. Primary endpoints of the analysis were local control (LC), out-of-field nodal progression-free survival (NPFS), overall progression-free survival (PFS), and overall survival (OS).

Results

109 patients and 155 lymph node metastases were evaluated. Patients’ median age was 70.8 years (range 51–84) and median PSA before SBRT was 1.88 ng/ml (range 0.3–45.5 ng/ml). The dose delivered to the target ranged from 25 to 48 Gy in 4–7 fractions; median BED1.5Gy was 198 Gy (range 108.3–432 Gy). With a median follow-up of 16 months, LC rates at 1 and 3 years were 93% and 86%, respectively. In-field progression of disease was observed in 11 (7%) lesions. One- and 3‑year NPFS was 59% and 29%, and median NPFS was 15 months. Rates of OS at 1 and 3 years were 100% and 95%. The median time to administration of a systemic treatment after SBRT was 7.8 months (1.7–54.8).

Conclusion

SBRT is an effective and well-tolerated treatment option in the management of lymph node metastases from PCa. Prospective trials are necessary to better select patients who benefit most from this ablative focal treatment and better define the recurrence patterns.

Keywords

Prostate cancer Stereotactic body radiotherapy Oligometastasis Metastases-directed therapies Radiotherapy 

Rezidivmuster nach stereotaktischer Radiotherapie beim oligometastasierten Prostatakarzinom: eine multiinstitutionelle Analyse

Zusammenfassung

Zielsetzung

Für Patienten mit oligometastasierten, oligorezidivierten oder oligoprogressiven Lymphknotenmetastasen bei Prostatakarzinom (PCa) stellt die zielgerichtete Behandlung mittels extrakranieller Körperstereotaxie (SBRT) eine neue Therapiestrategie dar. Ziel dieser retrospektiven Studie war die Analyse des onkologischen Outcomes sowie eine Rezidivmusteranalyse nach SBRT von Lymphknotenmetastasen beim Prostatakarzinom.

Methoden

In dieser multizentrischen Analyse wurden Patienten mit maximal fünf Lymphknotenmetastasen eines PCa eingeschlossen, welche mit SBRT behandelt wurden. Endpunkte der Analyse waren die lokale Kontrolle (LC), das progressionsfreie Überleben außerhalb des Bestrahlungsfelds (NPFS), das progressionsfreie Gesamtüberleben (PFS) und das Gesamtüberleben (OS).

Ergebnisse

Es wurden 155 Lymphknotenmetastasen von 109 Patienten mit einer SBRT behandelt. Das mediane Alter der Patienten betrug 70,8 Jahre (Spanne 51–84) und der mittlere PSA-Wert vor SBRT lag bei 1,88 ng/ml (Spanne 0,3–45,5 ng/ml). Insgesamt wurde eine Bestrahlungsdosis von 25 bis 48 Gy in 4–7 Fraktionen appliziert; die mittlere BED1,5Gy war 198 Gy (Spanne 108,3–432 Gy). Bei einem medianen Follow-up von 16 Monaten, lag die LC-Rate nach 1 und 3 Jahren bei jeweils 93 % und 86 %. Ein „in-field“-Progress wurde bei 11 Läsionen (7 %) beobachtet. Das NPFS nach einem und drei Jahren betrug 59 % und 29 % und der Median für NPFS war 15 Monate. Die OS-Rate betrug nach einem und drei Jahren jeweils 100 % und 95 %. Die mediane Zeit bis zur Einleitung einer systemischen Behandlung nach SBRT betrug 7,8 Monate (Spanne 1,7–54,8 Monate).

Schlussfolgerung

Bei der Behandlung von Lymphknotenmetastasen des PCa ist die SBRT eine wirksame und gut verträgliche Therapieoption. Prospektive Studien sind notwendig, um dieses vielversprechende Therapiekonzept genauer zu untersuchen.

Schlüsselwörter

Prostatakarzinom Extrakranielle Körperstereotaxie Oligometastasierung Metastasengerichtete Therapien Strahlentherapie 

Notes

Conflict of interest

L. Nicosia, C. Franzese, R. Mazzola, D. Franceschini, M. Rigo, G. D’agostino, S. Corradini, F. Alongi, and M. Scorsetti 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

  • Luca Nicosia
    • 1
  • Ciro Franzese
    • 2
  • Rosario Mazzola
    • 1
  • Davide Franceschini
    • 2
  • Michele Rigo
    • 1
  • Giuseppe D’agostino
    • 2
  • Stefanie Corradini
    • 3
  • Filippo Alongi
    • 1
    • 4
    • 5
    Email author
  • Marta Scorsetti
    • 2
  1. 1.Radiation OncologyIRCCS Sacro Cuore Don Calabria HospitalNegrar-VeronaItaly
  2. 2.Radiotherapy and Radiosurgery DepartmentHumanitas Clinical and Research HospitalMilan-RozzanoItaly
  3. 3.Radiation Oncology Department, University HospitalLMU MunichMunichGermany
  4. 4.University of BresciaBresciaItaly
  5. 5.Radiation Oncology DepartmentIRCCS Sacro Cuore Don Calabria Hospital, Cancer Care CenterVerona, NegrarItaly

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