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Stereotactic body radiotherapy to lymph nodes in oligoprogressive castration-resistant prostate cancer patients: a post hoc analysis from two phase I clinical trials

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Abstract

The prognosis of prostate cancer (PC) is generally favorable but the incidence of metastases is relatively high after the treatment of the primary tumor, especially in high-risk patients. Fractionated stereotactic body radiotherapy (SBRT) or single fraction stereotactic body radiosurgery (SRS) are emerging treatment options in this setting. However, data on SBRT/SRS in patients with metastatic castration-resistant PC (mCRPC) are largely lacking, particularly in subjects with nodal lesions. Therefore, we evaluated outcomes and toxicity recorded in mCRPC patients with nodal oligoprogression. Patients included in this analysis had ≤ 5 metastatic sites without visceral lesions and underwent SBRT/SRS on nodal metastases. Thirty-eight patients carrying out 61 nodal metastases were analyzed. The median SRS dose was 20 Gy (range 12–24 Gy) and the most common schedule was 20 Gy (44.8%). The median SBRT dose was 45 Gy (range 20–50 Gy) and the most common regimen was 45 Gy in 5 fractions (37.9%). Thirty-seven patients (97.4%) showed only grade 0–1 acute toxicity while one patient reported grade 2 dysphagia. In terms of late toxicity, one grade 2 laryngeal, one grade 1 skin and one grade 1 gastrointestinal toxicities were recorded. Two-year actuarial local control (LC), distant progression-free survival, progression-free survival (PFS) and overall survival were 94.0, 47.2, 47.2, and 90.2%, respectively. Two-year next line systemic therapy-free survival (NEST-FS) was 67.7%. In conclusion, the efficacy in terms of LC of SBRT/SRS in patients with nodal metastases from PC was confirmed. Moreover, this analysis suggests the efficacy in terms of PFS and NEST-FS also in the setting of oligoprogressive PC. In fact, about one-third of patients were free from progressive disease and two-third of subjects did not require hormonal therapy switch or discontinuation three years after treatment.

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Data availability

Data will be made available on reasonable request.

Abbreviations

PC:

Prostate cancer

ADT:

Androgen deprivation therapy

MDT:

Metastases directed therapies

SBRT:

Stereotactic body radiotherapy

SRS:

Single fraction stereotactic body radiosurgery

LC:

Local control

PFS:

Progression free survival

NEST-FS:

Time to next-line systemic treatment free survival

VMAT:

Volumetric modulated arc therapy

GTV:

Gross tumor volume

CT:

Computed tomography

PET:

CT- positron emission tomography

MRI:

Magnetic resonance imaging

PTV:

Planning target volume

ECOG-PS:

Eastern cooperative oncology group performance status

PSA:

Prostate serum antigen

DPFS:

Distant progression-free survival

OS:

Overall survival

BED:

Biologically effective dose

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Author notes

  1. D. Pezzulla and G. Macchia have contributed equally to this paper.

  2. A. G. Morganti and F. Deodato share the last authorship.

Authors and Affiliations

  1. Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy

    D. Pezzulla, G. Macchia, M. Ferro, P. Bonome & F. Deodato

  2. Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy

    S. Cilla & C. Romano

  3. Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    M. Buwenge, A. Zamagni & A. G. Morganti

  4. Department of Experimental, Diagnostic, and Specialty Medicine - DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy

    M. Buwenge, A. Zamagni & A. G. Morganti

  5. Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, IRCCS, UOC di Radioterapia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy

    V. Valentini

  6. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy

    V. Valentini & F. Deodato

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  1. D. Pezzulla
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  2. G. Macchia
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  3. S. Cilla
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  4. M. Buwenge
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  6. P. Bonome
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  8. A. Zamagni
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  9. V. Valentini
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  10. A. G. Morganti
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  11. F. Deodato
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Correspondence to G. Macchia.

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Pezzulla, D., Macchia, G., Cilla, S. et al. Stereotactic body radiotherapy to lymph nodes in oligoprogressive castration-resistant prostate cancer patients: a post hoc analysis from two phase I clinical trials. Clin Exp Metastasis 38, 519–526 (2021). https://doi.org/10.1007/s10585-021-10126-7

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  • DOI: https://doi.org/10.1007/s10585-021-10126-7

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