前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（PSMA-PET/CT）引导下的立体定向消融体部放射治疗寡转移前列腺癌：单机构经验及已发表文献综述

Prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT)-guided stereotactic ablative body radiotherapy for oligometastatic prostate cancer: a single-institution experience and review of the published literature.

作者信息

Ong Wee Loon, Koh Tze Lui, Lim Joon Daryl, Chao Michael, Farrugia Briana, Lau Eddie, Khoo Vincent, Lawrentschuk Nathan, Bolton Damien, Foroudi Farshad

机构信息

Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Vic., Australia.

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia.

出版信息

BJU Int. 2019 Nov;124 Suppl 1:19-30. doi: 10.1111/bju.14886. Epub 2019 Sep 11.

DOI:10.1111/bju.14886

PMID:31507035

Abstract

OBJECTIVES

To report the outcomes of stereotactic ablative body radiotherapy (SABR) in men with oligometastatic prostate cancer (PCa) diagnosed on prostate-specific membrane antigen (PSMA)-positron emission tomography/computed tomography (PET/CT), based on a single-institution experience and the published literature.

PATIENTS AND METHODS

This was a retrospective cohort study of the first 20 consecutive men with oligometastatic PCa, treated with SABR in a single institution, who had biochemical recurrence after previous curative treatment (surgery/radiotherapy), had no evidence of local recurrence, were not on palliative androgen deprivation therapy (ADT), and had PSMA-PET/CT-confirmed oligometastatic disease (≤3 lesions). These men were treated with SABR to a dose of 30 Gy in three fractions for bone metastases, and 35-40 Gy in five fractions for nodal metastases. The outcomes of interest were: PSA response; local progression-free survival (LPFS); distant progression-free survival (DPFS); and ADT-free survival (ADTFS). A literature review was performed to identify published studies reporting on outcomes of PSMA-PET/CT-guided SABR.

RESULTS

In our institutional cohort, 12 men (60%) had a decline in PSA post-SABR. One man had local progression 9.6 months post-SABR, with 12-month LPFS of 93%. Ten men had distant progression outside of their SABR treatment field, confirmed on PSMA-PET/CT, with 12-month DPFS of 62%, of whom four were treated with palliative ADT, two received prostate bed radiotherapy for prostate bed progression (confirmed on magnetic resonance imaging), and four received a further course of SABR (of whom one had further progression and was treated with palliative ADT). At last follow-up, six men (one with local progression and five with distant progression) had received palliative ADT. The 12-month ADTFS was 70%. Men with longer intervals between local curative treatment and SABR had better DPFS (P = 0.03) and ADTFS (P = 0.005). Four additional studies reporting on PSMA-PET/CT-guided SABR for oligometastatic PCa were identified and included in the review, giving a total of 346 patients. PSA decline was reported in 60-70% of men post-SABR. The 2-year LPFS, DPFS and ADTFS rates were 76-100%, 27-52%, and 58-62%, respectively.

CONCLUSION

Our results showed that PSMA-PET/CT could have an important role in identifying men with true oligometastatic PCa who would benefit the most from metastases-directed therapy with SABR.

摘要

目的

基于单机构经验和已发表文献，报告在前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）诊断为寡转移前列腺癌（PCa）的男性患者中，立体定向消融体部放疗（SABR）的治疗结果。

患者和方法

这是一项回顾性队列研究，纳入了连续20例在单一机构接受SABR治疗的寡转移PCa男性患者，这些患者在先前的根治性治疗（手术/放疗）后出现生化复发，无局部复发证据，未接受姑息性雄激素剥夺治疗（ADT），且经PSMA-PET/CT证实为寡转移疾病（≤3个病灶）。这些男性患者骨转移接受SABR治疗，分3次给予30 Gy剂量；淋巴结转移接受SABR治疗，分5次给予35 - 40 Gy剂量。感兴趣的结局指标包括：前列腺特异性抗原（PSA）反应；局部无进展生存期（LPFS）；远处无进展生存期（DPFS）；以及无ADT生存期（ADTFS）。进行文献综述以确定报告PSMA-PET/CT引导下SABR治疗结果的已发表研究。

结果

在我们的机构队列中，12例男性患者（60%）在SABR治疗后PSA下降。1例男性患者在SABR治疗后9.6个月出现局部进展，12个月的LPFS为93%。10例男性患者在SABR治疗区域外出现远处进展，经PSMA-PET/CT证实，12个月的DPFS为62%，其中4例接受了姑息性ADT治疗，2例因前列腺床进展（磁共振成像证实）接受了前列腺床放疗，4例接受了再次SABR治疗（其中1例出现进一步进展并接受了姑息性ADT治疗）。在最后一次随访时，6例男性患者（1例局部进展，5例远处进展）接受了姑息性ADT治疗。12个月的ADTFS为70%。局部根治性治疗与SABR之间间隔时间较长的男性患者具有更好的DPFS（P = 0.03）和ADTFS（P = 0.005）。另外还确定了4项报告PSMA-PET/CT引导下SABR治疗寡转移PCa的研究并纳入综述，共计346例患者。报告显示，60 - 70%的男性患者在SABR治疗后PSA下降。2年的LPFS、DPFS和ADTFS率分别为76 - 100%、27 - 52%和58 - 62%。