Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Investig Clin Urol. 2017 Sep;58(5):307-316. doi: 10.4111/icu.2017.58.5.307. Epub 2017 Aug 8.
Oligometastasis has been proposed as an intermediate stage of cancer spread between localized disease and widespread metastasis. Oligometastatic malignancy is now being diagnosed more frequently as the result of improvements in diagnostic modalities such as functional imaging. The importance of oligometastasis in managing metastatic prostate cancer is that it is possible to treat with a curative aim by metastasis-directed or local therapy in selected patients. Many studies have shown that these aggressive treatments lead to improved survival in other oligometastatic malignancies. However, few studies have shown definitive benefits of metastasis-directed or local therapy in oligometastatic prostate cancer. Review of the available studies suggests that stereotactic radiotherapy (RT) of metastatic lesions in oligorecurrent disease is a feasible and safe modality for managing oligometastatic prostate cancer. Also, stereotactic RT can delay the start of androgen deprivation therapy. Many retrospective studies of metastatic prostate cancer have shown that patients undergoing local therapy seem to have superior overall and cancer-specific survival compared with patients not receiving local therapy. Ongoing prospective randomized trials would be helpful to evaluate the role of local therapy in oligometastatic prostate cancer.
寡转移被认为是癌症从局限性疾病向广泛转移的中间阶段。随着功能成像等诊断方式的改进，寡转移性恶性肿瘤的诊断现在更为频繁。寡转移在治疗转移性前列腺癌中的重要性在于，对于某些患者，通过转移灶定向或局部治疗有可能达到治愈目的。许多研究表明，这些积极的治疗方法可提高其他寡转移恶性肿瘤的生存率。然而，在寡转移性前列腺癌中，很少有研究显示出转移灶定向或局部治疗的明确益处。对现有研究的回顾表明，寡复发疾病中转移性病变的立体定向放疗（RT）是治疗寡转移性前列腺癌的一种可行且安全的方法。此外，立体定向 RT 可以延迟开始雄激素剥夺治疗。许多转移性前列腺癌的回顾性研究表明，与未接受局部治疗的患者相比，接受局部治疗的患者似乎具有更好的总生存率和癌症特异性生存率。正在进行的前瞻性随机试验将有助于评估局部治疗在寡转移性前列腺癌中的作用。
