Academic Unit of Radiotherapy and Oncology, Royal Marsden NHS Foundation Trust, Chelsea, London, UK.
Cancer Research UK Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, UK.
Clin Oncol (R Coll Radiol). 2020 Aug;32(8):509-517. doi: 10.1016/j.clon.2020.03.008. Epub 2020 May 16.
Stereotactic body radiotherapy (SBRT) with the delayed option of androgen deprivation therapy (ADT) is the current treatment paradigm in men relapsed with oligometastatic prostate cancer based on the outcome of a phase II randomised controlled study. The immediate (concomitant) use of ADT in this clinical setting potentially augments the efficacy of SBRT by improving systemic disease control. The aim of this study was to compare the clinical outcomes of these two treatment strategies.
Eighty-eight patients with up to three oligometastases and controlled primary disease who had been treated using SBRT with immediate or delayed ADT were included in this retrospective analysis. Progression-free survival (PFS), widespread failure-free survival (WFFS) and freedom from further interventions (FFFI) were assessed using Kaplan-Meier and Cox proportional hazard regression methods. Toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE) v4.0.
Thirty-nine patients (44.3%) were treated with SBRT and immediate ADT (continuous ADT, n = 7; intermittent ADT, n = 32) and 49 (55.7%) with SBRT and delayed ADT. The median follow-up was 24 months (interquartile range 13.5-37.0 months). PFS in the immediate and delayed ADT groups were 26 months and 16 months, respectively (P < 0.007). The median WFFS in the immediate ADT group was not reached compared with 21 months in the delayed ADT group (P = 0.025). The 1- and 2-year FFFI in the immediate ADT group were 88% and 64.1%, respectively, significantly higher than those in the delayed ADT group (63.8% and 30.2%, respectively, P < 0.002). Acute toxicities of grade 1-2 occurred in 17.9% of the immediate ADT group and 18.4% of the delayed ADT group (P = 0.96). Only one case of grade 3 late toxicity (pelvic insufficiency) was identified in this study.
SBRT with concomitant ADT improves PFS, WFFS and FFFI as compared with SBRT with delayed ADT; this finding needs validation in a prospective, randomised study.
基于一项 II 期随机对照研究的结果，对于寡转移前列腺癌复发的患者，立体定向体部放疗（SBRT）联合延迟选择的去势治疗（ADT）是目前的治疗模式。在这种临床环境下，立即（同时）使用 ADT 可能通过改善全身疾病控制来增强 SBRT 的疗效。本研究旨在比较这两种治疗策略的临床结果。
本回顾性分析纳入了 88 例最多有 3 处寡转移病灶且初级肿瘤得到控制的患者，他们接受了 SBRT 联合立即或延迟 ADT 治疗。采用 Kaplan-Meier 法和 Cox 比例风险回归法评估无进展生存期（PFS）、广泛无失败生存期（WFFS）和无需进一步干预的生存期（FFFI）。采用通用不良事件术语标准（CTCAE）v4.0 评估毒性。
39 例（44.3%）患者接受 SBRT 联合立即 ADT（持续 ADT，n=7；间歇性 ADT，n=32）治疗，49 例（55.7%）患者接受 SBRT 联合延迟 ADT 治疗。中位随访时间为 24 个月（四分位距 13.5-37.0 个月）。立即 ADT 组和延迟 ADT 组的 PFS 分别为 26 个月和 16 个月（P<0.007）。立即 ADT 组的中位 WFFS 未达到，而延迟 ADT 组为 21 个月（P=0.025）。立即 ADT 组的 1 年和 2 年 FFFI 分别为 88%和 64.1%，显著高于延迟 ADT 组（分别为 63.8%和 30.2%，P<0.002）。立即 ADT 组和延迟 ADT 组的 1-2 级急性毒性发生率分别为 17.9%和 18.4%（P=0.96）。本研究仅发现 1 例 3 级晚期毒性（骨盆功能不全）病例。
与 SBRT 联合延迟 ADT 相比，SBRT 联合同时 ADT 可改善 PFS、WFFS 和 FFFI；这一发现需要在前瞻性、随机研究中得到验证。
