Advertisement

World Journal of Urology

, Volume 35, Issue 1, pp 45–49 | Cite as

Stereotactic body radiotherapy in oligometastatic prostate cancer patients with isolated lymph nodes involvement: a two-institution experience

  • Gianluca IngrossoEmail author
  • Fabio Trippa
  • Ernesto Maranzano
  • Alessandra Carosi
  • Elisabetta Ponti
  • Fabio Arcidiacono
  • Lorena Draghini
  • Luana Di Murro
  • Andrea Lancia
  • Riccardo Santoni
Original Article

Abstract

Objective

Stereotactic body radiotherapy (SBRT) is emerging as a treatment option in oligometastatic cancer patients. This retrospective study aimed to analyze local control, biochemical progression-free survival (b-PFS), and toxicity in patients affected by isolated prostate cancer lymph node metastases. Finally, we evaluated androgen deprivation therapy-free survival (ADT-FS).

Methods

Forty patients with 47 isolated lymph nodes of recurrent prostate cancer were treated with SBRT. Mostly, two different fractionation schemes were used: 5 × 7 Gy in 23 (48.9 %) lesions and 5 × 8 Gy in 13 (27.7 %) lesions. Response to treatment was assessed with periodical PSA evaluation. Toxicity was registered according to RTOG/EORTC criteria.

Results

With a mean follow-up of 30.18 months, local control was achieved in 98 % of the cases, with a median b-PFS of 24 months. We obtained a 2-year b-PFS of 44 % with 40 % of the patients ADT-free at last follow-up (mean value 26.18 months; range 3.96–59.46), whereas 12.5 % had a mean ADT-FS of 13.58 months (range 2.06–37.13). Late toxicity was observed in one (2.5 %) patient who manifested a grade 3 gastrointestinal toxicity 11.76 months after the end of SBRT.

Conclusion

Our study demonstrates that SBRT is safe, effective, and minimally invasive in the eradication of limited nodal metastases, yielding an important delay in prescribing ADT.

Keywords

Prostate cancer Oligometastasis Stereotactic body radiotherapy Local control Androgen deprivation therapy-free survival 

Notes

Authors’ contribution

Gianluca Ingrosso was involved in data collection and management and wrote the manuscript. Fabio Trippa and Elisabetta Ponti were involved in data collection and management and edited the manuscript. Ernesto Maranzano and Riccardo Santoni edited the manuscript. Alessandra Carosi was involved in data management and data analysis and wrote the manuscript. Fabio Arcidiacono and Lorena Draghini were involved in data collection and management. Luana Di Murro and Andrea Lancia wrote the manuscript.

Compliance with ethical standards

Ethical standards

In all patients, written informed consent was obtained.

References

  1. 1.
    Weichselbaum RR, Hellman S (2011) Oligometastases revisited. Nat Rev Clin Oncol 8:378–382PubMedGoogle Scholar
  2. 2.
    Schweizer MT, Zhou XC, Wang H, Yang T, Shaukat F, Partin AW, Eisenberg MA, Antonarakis ES (2013) Metastasis-free survival is associated with overall survival in men with PSA-recurrent prostate cancer treated with deferred androgen deprivation therapy. Ann Oncol 24:2881–2886CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ost P, Decaestecker K, Lambert B, Fonteyne V, Delrue L, Lumen N, Ameye F, De Meerleer G (2014) Prognostic factors influencing prostate cancer-specific survival in non-castrate patients with metastatic prostate cancer. Prostate 74:297–305CrossRefPubMedGoogle Scholar
  4. 4.
    Tree AC, Khoo VS, Eeles RA, Ahmed M, Dearnaley DP, Hawkins MA, Huddart RA, Nutting CM, Ostler PJ, van As NJ (2013) Stereotactic body radiotherapy for oligometastases. Lancet Oncol 14:e28–e37CrossRefPubMedGoogle Scholar
  5. 5.
    Ost P, Bossi A, Decaestecker K, De Meerleer G, Giannarini G, Karnes RJ, Roach M III, Briganti A (2015) Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: A systematic review of the literature. Eur Urol 67:852–863CrossRefPubMedGoogle Scholar
  6. 6.
    Taylor LG, Canfield SE, Du XL (2009) Review of major adverse effects of androgen-deprivation therapy in men with prostate cancer. Cancer 115:2388–2399CrossRefPubMedGoogle Scholar
  7. 7.
    Ponti E, Ingrosso G, Carosi A, Di Murro L, Lancia A, Pietrasanta F, Santoni R (2015) Salvage stereotactic body radiotherapy for patients with prostate cancer with isolated lymph node metastasis: A single-center experience. Clin Genitourin Cancer 13(4):e279–e284CrossRefPubMedGoogle Scholar
  8. 8.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247CrossRefPubMedGoogle Scholar
  9. 9.
    Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346CrossRefPubMedGoogle Scholar
  10. 10.
    Berkovic P, De Meerleer G, Delrue L, Lambert B, Fonteyne V, Lumen N, Decaestecker K, Villeirs G, Vuye P, Ost P (2013) Salvage stereotactic body radiotherapy for patients with limited prostate cancer metastases: deferring androgen deprivation therapy. Clin Genitourin Cancer 11(1):27–32CrossRefPubMedGoogle Scholar
  11. 11.
    Decaestecker K, De Meerleer G, Lambert B, Delrue L, Fonteyne V, Claeys T, De Vos F, Huysse W, Hautekiet A, Maes G, Ost P (2014) Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence. Radiat Oncol 12(9):135CrossRefGoogle Scholar
  12. 12.
    Casamassima F, Masi L, Menichelli C, Bonucci I, Casamassima E, Lazzeri M, Gulisano M, Aterini S (2011) Efficacy of eradicative radiotherapy for limited nodal metastases detected with choline PET scan in prostate cancer patients. Tumori 97(1):49–55PubMedGoogle Scholar
  13. 13.
    Picchio M, Berardi G, Fodor A, Busnardo E, Crivellaro C, Giovacchini G, Fiorino C, Kirienko M, Incerti E, Messa C, Gianolli L, Di Muzio N (2014) (11)C-Choline PET/CT as a guide to radiation treatment planning of lymph-node relapses in prostate cancer patients. Eur J Nucl Med Mol Imaging 41(7):1270–1279PubMedGoogle Scholar
  14. 14.
    Arcangeli S, Zilli T, De Bari B, Alongi F (2016) “Hit the primary”: a paradigm shift in the treatment of metastatic prostate cancer? Crit Rev Oncol Hematol 97:231–237CrossRefPubMedGoogle Scholar
  15. 15.
    Nuyttens JJ, Prevost JB, Van der Voort van Zijp NC, Hoogeman M, Levendag PC (2007) Curative stereotactic robotic radiotherapy treatment for extracranial, extrapulmonary, extrahepatic, and extraspinal tumors: technique, early results, and toxicity. Technol Cancer Res Treat 6(6):605–610CrossRefPubMedGoogle Scholar
  16. 16.
    Rusthoven CG, Carlson JA, Waxweiler TV, Yeh N, Raben D, Flaig TW, Kavanagh BD (2014) The prognostic significance of Gleason scores in metastatic prostate cancer. Urol Oncol 32(5):707–713CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Gianluca Ingrosso
    • 1
    Email author
  • Fabio Trippa
    • 2
  • Ernesto Maranzano
    • 2
  • Alessandra Carosi
    • 1
  • Elisabetta Ponti
    • 1
  • Fabio Arcidiacono
    • 2
  • Lorena Draghini
    • 2
  • Luana Di Murro
    • 1
  • Andrea Lancia
    • 1
  • Riccardo Santoni
    • 1
  1. 1.Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and RadiotherapyTor Vergata General HospitalRomeItaly
  2. 2.Department of Oncology, Radiation Oncology Center“S. Maria” HospitalTerniItaly

Personalised recommendations