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Stereotactic ablative radiation therapy for oligometastatic prostate cancer delays time-to-next systemic treatment

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Abstract

Purpose

Local ablative treatment to oligometastatic patients can result in long-term disease-free survival in some cancer patients. The importance of this treatment paradigm in prostate cancer is a rapidly evolving field. Herein, we report on the safety and preliminary clinical outcomes of a modern cohort of oligometastatic prostate cancer (OPC) patients treated with consolidative stereotactic ablative radiation (SABR).

Methods

Records of men with OPC who underwent consolidative SABR at our institution were reviewed. SABR was delivered in 1–5 fractions of 5–18 Gray. Kaplan–Meier estimates of local progression-free survival (LPFS), biochemical progression-free survival (bPFS; PSA nadir + 2), distant progression-free survival (DPFS), and time-to-next intervention (TTNI) were calculated.

Results

In total, 66 OPC patients were identified with consolidative SABR delivered to 134 metastases: 89 bone, 40 nodal, and 5 viscera. The majority of men (49/66) had hormone-sensitive prostate cancer (HSPC). Crude grade 1 and 2 acute toxicities were 36% and 11%, respectively, with no ≥ grade 3 toxicity. At 1 year, LPFS was 92% and bPFS and DPFS were 69%. Of the 18 men with HSPC who had deferred hormone therapy , 11 (56%) remain disease free following SABR (1-year ADT-FS was 78%). In 17 castration-resistant men, 11 had > 50% prostate-specific antigen (PSA) declines with 1-year TTNI of 30%.

Conclusions

Consolidative SABR in OPC is feasible and well tolerated. The heterogeneity and small size of our series limit extrapolation of clinically meaningful outcomes following consolidative SABR in OPC, but our preliminary data suggest that this approach warrants continued prospective study.

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Acknowledgements

PT Tran was supported by the Nesbitt-McMaster Foundation, Ronald Rose & Joan Lazar; Movember Foundation, Prostate Cancer Foundation; Commonwealth Foundation; NIH/NCI (R01CA166348 and U01CA2120007).

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Authors and Affiliations

  1. Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1550 Orleans Street, CRB2 Rm 406, Baltimore, MD, 21231, USA

    C. Leigh Moyer, Ryan Phillips, Matthew P. Deek, Noura Radwan, Jean Wright, Stephanie A. Terezakis, Daniel Y. Song, Curtiland DeVille, Theodore L. DeWeese & Phuoc T. Tran

  2. Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ashley E. Ross, Diane Reyes, Patrick C. Walsh, Theodore L. DeWeese, Michael Carducci, Edward M. Schaeffer, Kenneth J. Pienta, Mario Eisenberger & Phuoc T. Tran

  3. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ashley E. Ross, Emmanuel S. Antonarakis, Theodore L. DeWeese, Michael Carducci, Edward M. Schaeffer, Kenneth J. Pienta, Mario Eisenberger & Phuoc T. Tran

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  1. C. Leigh Moyer
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Contributions

CLM data collection or management, data analysis, and manuscript writing/editing. RP data collection or management, data analysis, and manuscript writing/editing. MPD manuscript writing/editing. NR data collection or management, data analysis, and manuscript writing/editing. AER protocol/project development, data collection or management, and manuscript writing/editing. ESA protocol/project development, data collection or management, and manuscript writing/editing. DR protocol/project development, data collection or management, and manuscript writing/editing. JW data collection or management and manuscript writing/editing. SAT data collection or management and manuscript writing/editing. DYS protocol/project development, data collection or management, and manuscript writing/editing. CD protocol/project development, data collection or management, and manuscript writing/editing. PCW protocol/project development and data collection or management. TLD protocol/project development and data collection or management. MC protocol/project development and data collection or management. EMS protocol/project development and data collection or management. KJP protocol/project development, data collection or management, and manuscript writing/editing. ME protocol/project development, data collection or management, data analysis, and manuscript writing/editing. PTT protocol/project development, data collection or management, data analysis, and manuscript writing/editing

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Correspondence to Phuoc T. Tran.

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Moyer, C.L., Phillips, R., Deek, M.P. et al. Stereotactic ablative radiation therapy for oligometastatic prostate cancer delays time-to-next systemic treatment. World J Urol 37, 2623–2629 (2019). https://doi.org/10.1007/s00345-018-2477-2

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