Decaestecker Karel, De Meerleer Gert, Lambert Bieke, Delrue Louke, Fonteyne Valérie, Claeys Tom, De Vos Filip, Huysse Wouter, Hautekiet Arne, Maes Gaethan, Ost Piet
Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
Radiat Oncol. 2014 Jun 12;9:135. doi: 10.1186/1748-717X-9-135.
To assess the outcome of prostate cancer (PCa) patients diagnosed with oligometastatic disease at recurrence and treated with stereotactic body radiotherapy (SBRT).
Non-castrate patients with up to 3 synchronous metastases (bone and/or lymph nodes) diagnosed on positron emission tomography - computed tomography, following biochemical recurrence after local curative treatment, were treated with (repeated) SBRT to a dose of 50 Gy in 10 fractions or 30 Gy in 3 fractions. Androgen deprivation therapy-free survival (ADT-FS) defined as the time interval between the first day of SBRT and the initiation of ADT was the primary endpoint. ADT was initiated if more than 3 metastases were detected during follow-up even when patients were still asymptomatic. Secondary endpoints were local control, progression free survival (PFS) and toxicity. Toxicity was scored using the Common Terminology Criteria for Adverse Events.
With a median follow-up from time of SBRT of 2 years, we treated 50 patients with 70 metastatic lesions with a local control rate of 100%. The primary involved metastatic sites were lymph nodes (54%), bone (44%), and viscera (2%). The median PFS was 19 mo (95% CI: 13-25 mo) with 75% of recurring patients having ≤3 metastases. A 2nd and 3rd course of SBRT was delivered in 19 and 6 patients respectively. This results in a median ADT-FS of 25 months (20-30 mo). On univariate analysis, only a short PSA doubling time was a significant predictor for both PFS (HR: 0.90, 95% CI: 0.82 - 0.99) and ADT-FS (HR: 0.83; 95% CI: 0.71 - 0.97). Ten patients (20%) developed toxicity following treatment, which was classified as grade I in 7 and grade II in 3 patients.
Repeated SBRT for oligometastatic prostate cancer postpones palliative androgen deprivation therapy with 2 years without grade III toxicity.
评估复发性寡转移前列腺癌（PCa）患者接受立体定向体部放疗（SBRT）的治疗结果。
在局部根治性治疗后生化复发，经正电子发射断层扫描 - 计算机断层扫描诊断出最多3个同步转移灶（骨和/或淋巴结）的非去势患者，接受（重复）SBRT治疗，剂量为50 Gy分10次或30 Gy分3次。无雄激素剥夺治疗生存期（ADT - FS）定义为SBRT第一天至开始ADT的时间间隔，为主要终点。如果在随访期间检测到超过3个转移灶，即使患者仍无症状，也开始ADT。次要终点为局部控制、无进展生存期（PFS）和毒性。使用不良事件通用术语标准对毒性进行评分。
SBRT后中位随访2年，我们治疗了50例患者的70个转移灶，局部控制率为100%。主要受累转移部位为淋巴结（54%）、骨（44%）和内脏（2%）。中位PFS为19个月（95%CI：13 - 25个月），75%的复发患者转移灶≤3个。分别有19例和6例患者接受了第二和第三疗程的SBRT。这导致中位ADT - FS为25个月（20 - 30个月）。单因素分析显示，只有较短的前列腺特异抗原（PSA）倍增时间是PFS（风险比：0.90，95%CI：0.82 - 0.99）和ADT - FS（风险比：0.83；95%CI：0.71 - 0.97）的显著预测因素。10例患者（20%）治疗后出现毒性反应，其中7例为I级，3例为II级。
复发性寡转移前列腺癌重复SBRT可使姑息性雄激素剥夺治疗推迟2年，且无III级毒性。
