Radiotherapy Oncology Operative Unit, Department of Medicine and Surgery and Translational Medicine, St Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 1, 50134, Florence, Italy.
Radiol Med. 2022 Jan;127(1):108-116. doi: 10.1007/s11547-021-01424-x. Epub 2021 Nov 8.
To retrospectively estimate the impact of radiotherapy as a progression-directed therapy (PDT) in oligoprogressive metastatic castration-resistant prostate cancer (mCRPC) patients under androgen receptor-target therapy (ARTT).
mCRPC patients are treated with PDT. End-points were time to next-line systemic treatment (NEST), radiological progression-free survival (r-PFS) and overall survival (OS). Toxicity was registered according to Common Terminology Criteria for Adverse Events v4.0. Survival analysis was performed using the Kaplan-Meier method; univariate and multivariate analyses were performed.
Fifty-seven patients were analyzed. The median follow-up after PDT was 25.2 months (interquartile, 17.1-44.5). One-year NEST-free survival, r-PFS and OS were 49.8%, 50.4% and 82.1%, respectively. At multivariate analysis, polymetastatic condition at diagnosis of metastatic hormone-sensitive prostate cancer (mHSPC) (HR 2.82, p = 0.004) and PSA doubling time at diagnosis of mCRPC (HR 2.76, p = 0.006) were associated with NEST-free survival. The same variables were associated with r-PFS (HR 2.32, p = 0.021; HR 2.24, p = 0.021). One patient developed late grade ≥ 2 toxicity.
Our study shows that radiotherapy in oligoprogressive mCRPC is safe, is effective and seems to prolong the efficacy of ARTT in patients who otherwise would have gone systemic treatment switch, positively affecting disease progression. Prospective trials are needed.
回顾性评估在雄激素受体靶向治疗（ARTT）下寡进展转移性去势抵抗性前列腺癌（mCRPC）患者中，作为进展定向治疗（PDT）的放疗的影响。
mCRPC 患者接受 PDT。终点为下一线系统治疗（NEST）时间、放射无进展生存期（r-PFS）和总生存期（OS）。毒性根据不良事件通用术语标准 4.0 版进行登记。使用 Kaplan-Meier 法进行生存分析；进行单变量和多变量分析。
分析了 57 例患者。PDT 后中位随访时间为 25.2 个月（四分位距，17.1-44.5）。一年无 NEST 生存率、r-PFS 和 OS 分别为 49.8%、50.4%和 82.1%。多变量分析显示，转移性激素敏感前列腺癌（mHSPC）诊断时的多灶性转移（HR 2.82，p=0.004）和 mCRPC 诊断时的 PSA 倍增时间（HR 2.76，p=0.006）与无 NEST 生存率相关。同样的变量与 r-PFS 相关（HR 2.32，p=0.021；HR 2.24，p=0.021）。1 例患者出现晚期≥2 级毒性。
我们的研究表明，寡进展性 mCRPC 中的放疗是安全的、有效的，并且似乎延长了否则将进行系统治疗转换的患者的 ARTT 疗效，对疾病进展产生积极影响。需要前瞻性试验。
