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Stereotactic ablative radiotherapy in castration-resistant prostate cancer patients with oligoprogression during androgen receptor-targeted therapy

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Abstract

Objectives

To report outcomes of stereotactic body radiotherapy (SBRT) in metastatic castration-resistant prostate cancer (mCRPC) patients with oligoprogression (≤ 5 metastases) during first-line treatment with androgen receptor-targeted therapy (ARTT).

Patients and methods

Retrospective multi-institutional analysis of mCRPC patients treated with SBRT to oligoprogressive lesions during ARTT. End-points were time to next-line systemic treatment (NEST), radiological progression-free survival (r-PFS) and overall survival (OS). Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Survival analysis was performed using the Kaplan–Meier method, univariate and multivariate analysis (MVA) were performed.

Results

Data from 34 patients were analyzed. Median NEST-free survival, r-PFS, and OS were 16.97, 13.47, and 38.3 months, respectively. At MVA, factors associated with worse NEST-free survival and r-PFS were polymetastatic burden at diagnosis of metastatic hormone-sensitive disease (hazard ratio [HR] 3.66, p = 0.009; HR 3.03, p = 0.034), PSA ≤ 7 ng/ml at mCRPC diagnosis (HR 0.23, p = 0.017; HR 0.19, p = 0.006) and PSADT ≤ 3 months at mCRPC diagnosis (HR 3.39, p = 0.026; HR 2.79, p = 0.037). Polymetastatic state at mHSPC diagnosis was associated with a decreased OS (HR 4.68, p = 0.029). No patient developed acute or late grade ≥ 2 toxicity.

Conclusion

Our results suggest that SBRT in oligoprogressive mCPRC is safe, effective and seems to prolong the efficacy of the ongoing systemic treatment positively affecting disease progression. Prospective trials are needed.

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Data availability

Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

Code availability

The software application for data storage is Excel and the software application for data analysis is SPSS.

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Funding

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Author information

Authors and Affiliations

  1. Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy

    G. Ingrosso & C. Aristei

  2. Department of Radiation Oncology, A.O.U Careggi, University of Florence, Florence, Italy

    B. Detti, G. Francolini & L. Livi

  3. Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy

    A. Fodor & N. Di Muzio

  4. Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Networking, Florence, Italy

    S. Caini

  5. Unit of Radiation Oncology, S. Donato Hospital, Arezzo, Italy

    S. Borghesi

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

    L. Triggiani & S. M. Magrini

  7. Department of Radiation Oncology, ‘S. Maria’ Hospital, Terni, Italy

    F. Trippa & E. Maranzano

  8. Radiotherapy Unit, Ospedale “Vito Fazzi”, Lecce, Italy

    D. Russo & D. Musio

  9. Radiotherapy Unit, University Hospital of Modena, Modena, Italy

    A. Bruni

  10. Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    A. Lancia

  11. Department of Medicine and Surgery and Translational Medicine, “Sapienza” University of Rome, Radiotherapy Oncology Operative Unit, St Andrea Hospital, Rome, Italy

    L. Marinelli & M. Valeriani

Authors
  1. G. Ingrosso
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  2. B. Detti
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  3. A. Fodor
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  4. S. Caini
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  6. L. Triggiani
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  7. F. Trippa
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  8. D. Russo
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  9. A. Bruni
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  10. G. Francolini
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  11. A. Lancia
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  12. L. Marinelli
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  19. M. Valeriani
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Contributions

Study concept and design: Ingrosso, Detti, Lancia, Valeriani. Acquisition of data: Ingrosso, Detti, Fodor, Borghesi, Triggiani, Trippa, Russo, Bruni, Francolini, Marinelli. Analysis and interpretation of data: Caini, Detti, Ingrosso, Lancia. Drafting of the manuscript: Ingrosso, Detti, Caini, Livi, Aristei, Di Muzio. Critical revision of the manuscript for important intellectual content: Magrini, Triggiani, Maranzano, Musio, Valeriani, Fodor, Livi. Statistical analysis: Caini, Ingrosso, Detti. Supervision: Magrini, Livi, Musio, Maranzano, Di Muzio, Aristei. All authors have made a substantial contribution to research design, or the acquisition, analysis or interpretation of data. All authors have drafted the paper and revised it critically and have approved the submitted final version.

Corresponding author

Correspondence to G. Ingrosso.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was waived by the local Ethics Committee of University of Perugia in view of the retrospective nature of the study and all the procedures being performed were part of routine care. The study was performed according to the Declaration of Helsinki and written informed consent was obtained for all patients.

Informed consent

All patients provided informed consent for this retrospective multi-institutional analysis.

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All patients provided informed consent for publication, and no identifying information is included in this article.

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Ingrosso, G., Detti, B., Fodor, A. et al. Stereotactic ablative radiotherapy in castration-resistant prostate cancer patients with oligoprogression during androgen receptor-targeted therapy. Clin Transl Oncol 23, 1577–1584 (2021). https://doi.org/10.1007/s12094-021-02553-5

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  • DOI: https://doi.org/10.1007/s12094-021-02553-5

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