Faculty of Medicine, Department of Radiation Oncology, Hacettepe University, Ankara, Turkey.
Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University, Adana, Turkey.
Strahlenther Onkol. 2020 Nov;196(11):1034-1043. doi: 10.1007/s00066-020-01660-6. Epub 2020 Jul 2.
The aim of this study was to evaluate the outcomes of Ga prostate-specific membrane antigen (Ga-PSMA) positron-emission tomography (PET)/CT-based metastasis-directed treatment (MDT) for oligometastatic prostate cancer (PC).
In this multi-institutional study, clinical data of 176 PC patients with 353 lesions receiving MDT between 2014 and 2019 were retrospectively evaluated. All patients had biopsy proven PC with ≤5 metastases detected with Ga-PSMA-PET/CT. MDT was delivered with conventional fractionation or stereotactic body radiotherapy (SBRT) techniques. CTCAE v4.0 was used for acute and RTOG/EORTC Late Radiation Morbidity Scoring Schema was used for late toxicity evaluation.
At the time of MDT, 59 patients (33.5%) had synchronous and 117 patients (66.5%) had metachronous metastases. Median number of metastases was one and the MDT technique was SBRT in 73.3% patients. The 2‑year overall survival (OS) and progression-free survival (PFS) rates were 87.6% and 63.1%, respectively. With a median follow-up of 22.9 months, 9 patients had local recurrence at the irradiated site. The 2‑year local control rate at the treated oligometastatic site per patient was 93.2%. In multivariate analysis, an increased number of oligometastases and untreated primary PC were negative predictors for OS; advanced clinical tumor stage, untreated primary PC, BED3 value of ≤108 Gy, and MDT with conventional fractionation were negative predictors for PFS. No patient experienced grade ≥3 acute toxicity, but one patient had a late grade 3 toxicity of compression fracture after spinal SBRT.
Ga-PSMA-PET/CT-based MDT is an efficient and safe treatment for oligometastatic PC patients. Proper patient selection might improve treatment outcomes.
本研究旨在评估基于镓前列腺特异性膜抗原（Ga-PSMA）正电子发射断层扫描（PET）/CT 的转移灶定向治疗（MDT）治疗寡转移前列腺癌（PC）的疗效。
在这项多中心研究中，回顾性分析了 2014 年至 2019 年间接受 MDT 的 176 例 353 处病灶的 PC 患者的临床资料。所有患者均经活检证实为 PC，且 Ga-PSMA-PET/CT 检测到≤5 处转移灶。MDT 采用常规分割或立体定向体部放疗（SBRT）技术。采用 CTCAE v4.0 进行急性毒性评估，采用 RTOG/EORTC 晚期放射损伤评分方案进行晚期毒性评估。
在 MDT 时，59 例（33.5%）患者为同步转移，117 例（66.5%）患者为异时转移。转移灶的中位数为 1 个，73.3%的患者采用 SBRT 作为 MDT 技术。2 年总生存率（OS）和无进展生存率（PFS）分别为 87.6%和 63.1%。中位随访 22.9 个月，9 例患者在照射部位出现局部复发。每位患者治疗的寡转移部位的 2 年局部控制率为 93.2%。多因素分析显示，寡转移灶数量增加和未治疗的原发 PC 是 OS 的负预测因素；临床肿瘤分期较晚、未治疗的原发 PC、BED3 值≤108 Gy 和采用常规分割的 MDT 是 PFS 的负预测因素。无患者发生≥3 级急性毒性反应，但 1 例接受脊柱 SBRT 的患者发生晚期 3 级毒性反应——压缩性骨折。
基于 Ga-PSMA-PET/CT 的 MDT 是治疗寡转移 PC 患者的有效且安全的方法。适当的患者选择可能会改善治疗结果。
