Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.
Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
Eur Urol. 2015 May;67(5):852-63. doi: 10.1016/j.eururo.2014.09.004. Epub 2014 Sep 17.
The introduction of novel imaging modalities has increased the detection of oligometastatic prostate cancer (PCa) recurrence, potentially justifying the use of a metastasis-directed therapy (MDT) with surgery or radiotherapy (RT) rather than a systemic approach.
To perform a systematic review of MDT for oligometastatic PCa recurrence.
This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched the Medline and Embase databases from 1946 to February 2014 for studies reporting on biochemical or clinical progression and/or toxicity or complications of MDT (RT or surgery). Reports were excluded if these end points could not be ascertained or separately analysed, or if insufficient details were provided. Methodological quality was assessed using an 18-item validated quality appraisal tool for case series.
Fifteen single-arm case series reporting on a total of 450 patients met the inclusion criteria. Seven studies were considered of acceptable quality. Oligometastatic PCa recurrence was diagnosed with positron emission tomography with coregistered computed tomography in most of the patients (98%). Nodal, bone, and visceral metastases were treated in 78%, 21%, and 1%, respectively. Patients were treated with either RT (66%) or lymph node dissection (LND) (34%). Adjuvant androgen deprivation was given in 61% of patients (n=275). In the case of nodal metastases, prophylactic nodal irradiation was administered in 49% of patients (n=172). Overall, 51% of patients were progression free 1-3 yr after salvage MDT, with most of them receiving adjuvant treatment. For RT, grade 2 toxicity was observed in 8.5% of patients, with one case of grade 3 toxicity. In the case of LND, 11% and 12% of grade 2 and grade 3 complications, respectively, were reported.
MDT is a promising approach for oligometastatic PCa recurrence, but the low level of evidence generated by small case series does not allow extrapolation to a standard of care.
We performed a systematic review to assess complications and outcomes of treating oligometastatic prostate cancer recurrence with surgery or radiotherapy. We concluded that although this approach is promising, it requires validation in randomised controlled trials.
新的成像方式的出现增加了寡转移前列腺癌（PCa）复发的检出率，这可能使采用针对转移灶的治疗方法（手术或放疗）来治疗成为可能，而不是采用全身性治疗。
对寡转移前列腺癌复发的多模式治疗进行系统综述。
本系统综述根据系统评价和荟萃分析的首选报告项目进行。我们检索了 Medline 和 Embase 数据库，以获取自 1946 年至 2014 年 2 月期间报告生化或临床进展以及/或多模式治疗（放疗或手术）的毒性或并发症的研究。如果无法确定或单独分析这些终点，或者如果提供的细节不足，则排除报告。使用针对病例系列的 18 项经过验证的质量评估工具评估方法学质量。
符合纳入标准的共有 15 项单臂病例系列研究，共纳入 450 例患者。7 项研究被认为质量尚可。大多数患者（98%）采用正电子发射断层扫描与计算机断层融合技术诊断寡转移前列腺癌复发。分别有 78%、21%和 1%的患者治疗淋巴结、骨骼和内脏转移。患者分别接受放疗（66%）或淋巴结清扫术（34%）。61%的患者（n=275）接受辅助雄激素剥夺治疗。对于淋巴结转移，49%的患者（n=172）接受预防性淋巴结照射。总的来说，在挽救性多模式治疗后 1-3 年，51%的患者无进展，其中大多数患者接受辅助治疗。对于放疗，8.5%的患者出现 2 级毒性，有 1 例 3 级毒性。对于淋巴结清扫术，分别有 11%和 12%的患者发生 2 级和 3 级并发症。
多模式治疗是治疗寡转移前列腺癌复发的一种很有前途的方法，但小病例系列产生的低证据水平不允许推断为标准治疗。
我们进行了一项系统综述，以评估手术或放疗治疗寡转移前列腺癌复发的并发症和结果。我们的结论是，尽管这种方法很有前景，但它需要在随机对照试验中得到验证。
