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PSMA-guided metastases directed therapy for bone castration sensitive oligometastatic prostate cancer: a multi-institutional study

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Abstract

To assess the outcomes of a cohort of bone oligometastatic prostate cancer patients treated with PSMA-PET guided stereotactic body radiotherapy (SBRT). From April 2017 to January 2021, 40 patients with oligorecurrent prostate cancer detected by PSMA-PET were treated with SBRT for bone oligometastases. Concurrent androgen deprivation therapy was an exclusion criterion. A total of 56 prostate cancer bone oligometastases were included in the present analysis. In 28 patients (70%), oligometastatic disease presented as a single lesion, two lesions in 22.5%, three lesions in 5%, four lesions in 2.5%. 30.3% were spine-metastases, while 69.7% were non-spine metastases. SBRT was delivered for a median dose of 30 Gy (24–40 Gy) in 3–5 fractions, with a median EQD2 = 85 Gy2 (64.3—138.9Gy2). With a median follow-up of 22 months (range 2–48 months), local control (LC) 1- and 2-years rates were 96.3% and 93.9%, while distant progression-free survival (DPFS) rates were 45.3% and 27%. At multivariate analysis, the lower PSA nadir value after SBRT remained significantly related to better DPFS rates (p = 0.03). In 7 patients, a second SBRT course was proposed with concurrent ADT, while 11 patients, due to polymetastatic spread, received ADT alone, resulting in 1- and 2-years ADT-free survival rates of 67.5% and 61.8%. At multivariate analysis, a lower number of treated oligometastases maintained a correlation with higher ADT-free survival rates (p = 0.04). In our experience, PSMA-PET guided SBRT resulted in excellent results in terms of clinical outcomes, representing a helpful tool with the aim to delay the start of ADT.

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Authors and Affiliations

  1. Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy

    Rosario Mazzola, Francesco Cuccia, Edoardo Pastorello & Filippo Alongi

  2. Nuclear Medicine Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy

    Matteo Salgarello

  3. Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy

    Giulio Francolini & Lorenzo Livi

  4. Department of Biomedical, Experimental and Clinical Sciences,’’Mario Seri’’, University of Florence, Florence, Italy

    Giulio Francolini & Lorenzo Livi

  5. Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy

    Luca Triggiani & Stefano Maria Magrini

  6. Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy

    Gianluca Ingrosso & Cynthia Aristei

  7. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy

    Ciro Franzese & Marta Scorsetti

  8. Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy

    Ciro Franzese & Marta Scorsetti

  9. University of Brescia, Brescia, Italy

    Filippo Alongi

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  1. Rosario Mazzola
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  2. Francesco Cuccia
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  5. Giulio Francolini
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  8. Stefano Maria Magrini
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  9. Gianluca Ingrosso
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  11. Ciro Franzese
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Correspondence to Francesco Cuccia.

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Mazzola, R., Cuccia, F., Pastorello, E. et al. PSMA-guided metastases directed therapy for bone castration sensitive oligometastatic prostate cancer: a multi-institutional study. Clin Exp Metastasis 39, 443–448 (2022). https://doi.org/10.1007/s10585-022-10157-8

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  • DOI: https://doi.org/10.1007/s10585-022-10157-8

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