Schmidt-Hegemann N-S, Kroeze S G C, Henkenberens C, Vogel M M E, Kirste S, Becker J, Burger I A, Derlin T, Bartenstein P, Eiber M, Mix M, la Fougère Ch, Müller A C, Grosu A L, Combs S E, Christiansen H, Guckenberger M, Belka C
Department of Radiation Oncology, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Department of Radiation Oncology, University Hospital Zürich, Zurich, Switzerland.
Eur J Nucl Med Mol Imaging. 2020 Jul;47(8):1852-1863. doi: 10.1007/s00259-020-04708-y. Epub 2020 Jan 30.
Approximately 40-70% of biochemically persistent or recurrent prostate cancer (PCa) patients after radical prostatectomy (RPE) are oligo-metastatic in gallium-prostate-specific membrane antigen positron emission tomography (Ga-PSMA PET). Those lesions are frequently located outside the prostate bed, and therefore not cured by the current standards of care like external-beam radiotherapy (EBRT) of the prostatic fossa. This retrospective study analyzes the influence of oligo-metastases' site on outcome after metastasis-directed radiotherapy (MDR).
Retrospectively, 359 patients with PET-positive PCa recurrences after RPE were analyzed. Biochemical recurrence-free survival (BRFS) (prostate-specific antigen (PSA) < post-radiotherapy nadir + 0.2 ng/mL) was assessed using Kaplan-Meier survival and Cox regression analysis.
All patients were initially clinically without distant metastases (cM0). Seventy-five patients had local recurrence within the prostatic fossa, 32 patients had pelvic nodal plus local recurrence, 117 patients had pelvic nodal recurrence, 51 patients had paraaortic lymph node metastases with/without locoregional recurrence, and 84 patients had bone or visceral metastases with/without locoregional recurrence. Median PSA before MDR was 1.2 ng/mL (range, 0.04-47.5). Additive androgen deprivation therapy (ADT) was given in 35% (125/359) of patients. Median PSA nadir after MDR was 0.23 ng/mL (range, < 0.03-18.30). After a median follow-up of 16 months (1-57), 239/351 (68%) patients had no biochemical recurrence. Patients with distant lymph node and/or distant metastases, the so-called oligo-body cohort, had an overall in-field control of 90/98 (91%) but at the same time, an ex-field progress of 44/96 (46%). In comparison, an ex-field progress was detected in 28/154 (18%) patients with local and/or pelvic nodal recurrence (oligo-pelvis group). Compared with the oligo-pelvis group, there was a significantly lower BRFS in oligo-body patients at the last follow-up.
Overall, BRFS was dependent on patterns of metastatic disease. Thus, MDR of PSMA PET-positive oligo-metastases can be offered considering that about one-third of the patients progressed within a median follow-up of 16 months.
在根治性前列腺切除术（RPE）后，约40%-70%生化指标持续存在或复发的前列腺癌（PCa）患者在镓-前列腺特异性膜抗原正电子发射断层扫描（Ga-PSMA PET）中为寡转移。这些病灶常位于前列腺床外，因此无法通过当前的标准治疗方法如前列腺窝外照射放疗（EBRT）治愈。本回顾性研究分析寡转移部位对转移导向放疗（MDR）后结局的影响。
回顾性分析359例RPE后PET阳性PCa复发患者。采用Kaplan-Meier生存分析和Cox回归分析评估生化无复发生存期（BRFS）（前列腺特异性抗原（PSA）<放疗后最低点+0.2 ng/mL）。
所有患者最初临床均无远处转移（cM0）。75例患者在前列腺窝内局部复发，32例患者盆腔淋巴结及局部复发，117例患者盆腔淋巴结复发，51例患者腹主动脉旁淋巴结转移伴/不伴局部区域复发，84例患者骨或内脏转移伴/不伴局部区域复发。MDR前PSA中位数为1.2 ng/mL（范围0.04-47.5）。35%（125/359）的患者接受了辅助雄激素剥夺治疗（ADT）。MDR后PSA最低点中位数为0.23 ng/mL（范围<0.03-18.30）。中位随访16个月（1-57个月）后，239/351（68%）例患者无生化复发。有远处淋巴结和/或远处转移的患者，即所谓的寡转移灶组，野内总体控制率为90/98（91%），但同时，野外进展率为44/96（46%）。相比之下，154例局部和/或盆腔淋巴结复发患者（寡转移盆腔组）中有28例（18%）出现野外进展。与寡转移盆腔组相比，寡转移灶组在最后一次随访时的BRFS显著更低。
总体而言，BRFS取决于转移疾病模式。因此，考虑到约三分之一的患者在16个月的中位随访期内出现进展，可对PSMA PET阳性寡转移灶进行MDR。
