Deodato F, Pezzulla D, Cilla S, Ferro M, Romano C, Bonome P, Buwenge M, Zamagni A, Strigari L, Valentini V, Morganti A G, Macchia G
Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy.
Radiology Institute, Università Cattolica del Sacro Cuore, 00135, Rome, Italy.
Clin Transl Oncol. 2022 Jun;24(6):1177-1183. doi: 10.1007/s12094-021-02764-w. Epub 2022 Jan 4.
Aim of this analysis was to report toxicity and clinical outcomes in oligorecurrent prostate cancer (PCa) patients treated with single fraction stereotactic radiosurgery (SRS) for bone metastases.
We separately analyzed clinical data of PCa patients with bone oligometastases enrolled in a prospective phase I trial (DESTROY-2). DESTROY-2 was based on SRS delivered using volumetric modulated arc therapy in patients with primary or metastatic tumors in several extra-cranial body sites. Acute and late toxicity, biochemical tumor response, local control (LC), distant metastases-free (DPFS), progression-free (PFS), time to next-line systemic treatment-free (NEST-FS), and overall survival (OS) were calculated.
Data on 37 PCa patients, carrying out 50 bone metastases, candidates for curative-intent treatment and treated with SRS at our Institution were collected. SRS dose ranged between 12 and 24 Gy. One grade 1 acute skin toxicity in one patient treated on the hip (24 Gy) and one grade 1 late skin toxicity in a patient with a scapular lesion (24 Gy) were recorded. No cases of bone fracture were registered in the treated population. With a median follow-up of 25 months (range 3-72 months) 2-year actuarial LC, DPFS, PFS, and OS were 96.7%, 58.1%, 58.1%, and 95.8%, respectively. Median and 2-year NEST-FS were 30 months (range 1-69 months) and 51.2%, respectively.
Data analysis showed few toxicity events, high local control rate and prolonged NEST-FS after linear accelerator-based radiosurgery of bone oligometastases from PCa. The possibility of postponing systemic treatments in patients with oligometastatic PCa by means of SRS should be taken into account. Further prospective studies on larger series are needed to confirm the reported results.
本分析的目的是报告寡转移复发性前列腺癌（PCa）患者接受单分割立体定向放射外科治疗（SRS）骨转移的毒性和临床结果。
我们分别分析了参加一项前瞻性I期试验（DESTROY-2）的PCa骨寡转移患者的临床数据。DESTROY-2基于容积调强弧形放疗对多个颅外身体部位的原发性或转移性肿瘤患者进行SRS治疗。计算急性和晚期毒性、生化肿瘤反应、局部控制（LC）、无远处转移（DPFS）、无进展（PFS）、无下一线全身治疗时间（NEST-FS）和总生存期（OS）。
收集了37例PCa患者的数据，这些患者有50处骨转移，有治愈意向治疗的候选资格并在我们机构接受了SRS治疗。SRS剂量在12至24 Gy之间。记录到1例接受髋部治疗（24 Gy）的患者出现1级急性皮肤毒性，1例肩胛骨病变患者（24 Gy）出现1级晚期皮肤毒性。在治疗人群中未记录到骨折病例。中位随访25个月（范围3至72个月），2年精算LC、DPFS、PFS和OS分别为96.7%、58.1%、58.1%和95.8%。中位和2年NEST-FS分别为30个月（范围1至69个月）和51.2%。
数据分析显示，基于直线加速器的PCa骨寡转移放射外科治疗后毒性事件较少，局部控制率高，NEST-FS延长。应考虑通过SRS推迟寡转移PCa患者全身治疗的可能性。需要对更大系列进行进一步的前瞻性研究以证实报告的结果。
