Henkenberens Christoph, Derlin Thorsten, Bengel Frank, Ross Tobias L, Kuczyk Markus A, Giordano Frank A, Sarria Gustavo R, Schmeel Leonard Christopher, Christiansen Hans, von Klot Christoph A J
Department of Radiotherapy and Special Oncology, Hannover Medical School, Hannover, Germany.
Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany.
Front Oncol. 2021 Apr 19;11:664225. doi: 10.3389/fonc.2021.664225. eCollection 2021.
To assess the outcome of radiotherapy (RT) to all PSMA ligand positive metastases for patients with castrate-resistant prostate cancer (mCRPC).
A total of 42 patients developed oligometastatic mCRPC and received PSMA PET-guided RT of all metastases. The main outcome parameters were biochemical progression-free survival (bPFS), and second-line systemic treatment free survival (SST-FS).
A total of 141 PSMA ligand-positive metastases were irradiated. The median follow-up time was 39.0 months (12-58 months). During the follow-up five out of 42 (11.9%) patients died of progressive mPCa. Five out of 42 (11.9%) patients showed no biochemical responses and presented with a PSA level ≥10% of the baseline PSA at first PSA level measurement after RT and were classified as non-responders. The median PSA level before RT was 4.79 ng/mL (range, 0.4-46.1), which decreased significantly to a median PSA nadir level of 0.39 ng/mL (range, <0.07-32.8; p=0.002). The median PSA level at biochemical progression after PSMA ligand-based RT was 2.75 ng/mL (range, 0.27-53.0; p=0.24) and was not significantly different (p=0.29) from the median PSA level (4.79 ng/mL, range, 0.4-46.1) before the PSMA ligand-based RT. The median bPFS was 12.0 months after PSMA ligand PET-based RT (95% CI, 11.2-15.8) and the median SST-FS was 15.0 months (95% CI, 14.0-21.5).
In well-informed and closely followed-up patients, PSMA PET-guided RT represents a viable treatment option for patients with oligometastatic mCRPC to delay further systemic therapies.
评估去势抵抗性前列腺癌（mCRPC）患者对所有前列腺特异性膜抗原（PSMA）配体阳性转移灶进行放射治疗（RT）的疗效。
共有42例患者发生寡转移mCRPC，并接受了所有转移灶的PSMA正电子发射断层扫描（PET）引导下的放疗。主要结局参数为生化无进展生存期（bPFS）和无二线全身治疗生存期（SST-FS）。
共照射了141个PSMA配体阳性转移灶。中位随访时间为39.0个月（12 - 58个月）。随访期间，42例患者中有5例（11.9%）死于进展性转移性前列腺癌（mPCa）。42例患者中有5例（11.9%）未出现生化反应，在放疗后的首次前列腺特异性抗原（PSA）水平测量时，PSA水平≥基线PSA的10%，被归类为无反应者。放疗前的中位PSA水平为4.79 ng/mL（范围0.4 - 46.1），显著下降至中位PSA最低点水平0.39 ng/mL（范围<0.07 - 32.8；p = 0.002）。基于PSMA配体的放疗后生化进展时的中位PSA水平为2.75 ng/mL（范围0.27 - 53.0；p = 0.24），与基于PSMA配体的放疗前的中位PSA水平（4.79 ng/mL，范围0.4 - 46.1）无显著差异（p = 0.29）。基于PSMA配体PET的放疗后的中位bPFS为12.0个月（95%置信区间，11.2 - 15.8），中位SST-FS为15.0个月（95%置信区间，14.0 - 21.5）。
在充分知情且密切随访的患者中，PSMA PET引导下的放疗是寡转移mCRPC患者延迟进一步全身治疗的可行治疗选择。
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