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Stereotactic radiotherapy to oligoprogressive lesions detected with 68Ga-PSMA-PET/CT in castration-resistant prostate cancer patients

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Abstract

Purpose

We assessed the outcomes of stereotactic body radiotherapy (SBRT) to treat oligoprogressive castration-resistant prostate cancer (CRPC) patients with ≤5 lesions using gallium prostate–specific membrane antigen-positron emission tomography (68Ga-PSMA-PET/CT).

Methods

The clinical data of 67 CRPC patients with 133 lesions treated with 68Ga-PSMA-PET/CT-based SBRT were retrospectively analyzed. All of the patients had oligoprogressive disease during androgen-deprivation therapy (ADT). The prognostic factors for overall- (OS) and progression-free survival (PFS) and the predictive factors for switching to next-line systemic treatment (NEST) and NEST-free survival (NEST-FS) were analyzed.

Results

With a median follow-up of 17.5 months, the 2-year overall survival (OS) and PFS rates were 86.9% and 34.4%, respectively. The PSA response was observed in 49 patients (73.1%). Progression was observed in 37 patients (55.2%) at a median of 11.0 months following SBRT. A total of 45 patients (67.2%) remained on ADT after SBRT, and 22 patients (32.8%) had a NEST change at a median of 16.4 months after metastasis-directed treatment (MDT). Patients with a NEST change had higher post-SBRT PSA values and fewer PSA nadirs after MDT than their counterparts. In multivariate analysis, higher pre-SBRT PSA values were the only significant predictor for worse OS and NEST-FS, and no significant factor was found for PFS. No serious acute or late toxicities were observed.

Conclusion

This study demonstrated the feasibility of MDT using SBRT to treat oligoprogressive lesions by 68Ga-PSMA-PET/CT in CRPC patients is efficient and well-tolerated, prolonging the effectiveness of ADT by delaying NEST.

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Data availability

The datasets analyzed during this study are available from the corresponding author on reasonable request.

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Funding

The study was supported by Baskent University Research Fund.

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Authors and Affiliations

  1. Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, 01120, Adana, Turkey

    Cem Onal & Ozan Cem Guler

  2. Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Gokhan Ozyigit, Burak Tilki, Pervin Hurmuz & Fadil Akyol

  3. Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey

    Ezgi Oymak

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  1. Cem Onal
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Contributions

Conception and design, CO, GO, FA; collection and assembly of data, EO, OCG, BT, PH; interpretation of the data, CO, PH, BT; data analysis, CO and GO; drafting of the article, CO, GO, EO, FA; technical or logistic support, OCG, BT; all the authors approved the final manuscript.

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Correspondence to Cem Onal.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethical committee.

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Onal, C., Ozyigit, G., Oymak, E. et al. Stereotactic radiotherapy to oligoprogressive lesions detected with 68Ga-PSMA-PET/CT in castration-resistant prostate cancer patients. Eur J Nucl Med Mol Imaging 48, 3683–3692 (2021). https://doi.org/10.1007/s00259-021-05298-z

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