Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy.
Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy.
Clin Exp Metastasis. 2022 Jun;39(3):449-457. doi: 10.1007/s10585-022-10158-7. Epub 2022 Feb 21.
Oligoprogression is defined as limited metastatic clone resistant to on-going systemic treatment that grows in a background of stable or responding systemic disease. Aim of the present study was to analyze oligoprogressive prostate cancer (PC) patients treated with stereotactic body radiation therapy (SBRT) during systemic treatment to identify predictive factors and improve patients' selection. We included PC patients treated with SBRT on a maximum of 3 sites of oligoprogression during systemic therapy. Endpoints were freedom from polymetastatic progression (FPP), local control (LC), distant progression free survival (DPFS), overall survival (OS), and next systemic therapy free survival (NEST-FS). Fifty-three patients were treated on 85 oligoprogressive metastases. Lymph nodes were the most common sites (56.47%), followed by bone (39.29%). Median follow-up was 24.9 months. Rates of FPP at 1- and 2-year were 80.1% and 68.9%, respectively. Median time to polymetastatic progression was 33.7 months. Disease free interval (p = 0.004), site of metastases (p = 0.011), and type of systemic therapy (p = 0.003) were significant for FPP. Switch or intensification of systemic therapy after SBRT was observed in 29 (54.72%) patients with a median NEST-FS of 15.2 months. LC at 1- and 2-year was 94.0% and 92.0%, with PSA doubling time resulted to be significantly associated (p = 0.047). Median DPFS was 8.93 months and median OS was 50.6 months. In conclusion, we confirmed the efficacy of SBRT for oligoprogression from PC, with the potential to prolong the on-going systemic therapy and interrupt the metastatic cascade.
寡进展是指对正在进行的系统治疗具有耐药性的有限转移克隆，在稳定或应答性全身疾病的背景下生长。本研究的目的是分析在系统治疗期间接受立体定向体部放射治疗（SBRT）治疗的寡进展性前列腺癌（PC）患者，以确定预测因素并改善患者选择。我们纳入了在系统治疗期间接受 SBRT 治疗的最大 3 个寡进展部位的 PC 患者。终点是无多灶转移进展（FPP）、局部控制（LC）、远处无进展生存（DPFS）、总生存（OS）和下一次无系统治疗生存（NEST-FS）。53 例患者在 85 个寡进展转移部位接受治疗。淋巴结是最常见的部位（56.47%），其次是骨（39.29%）。中位随访时间为 24.9 个月。1 年和 2 年的 FPP 率分别为 80.1%和 68.9%。多灶转移的中位时间为 33.7 个月。无疾病间隔（p=0.004）、转移部位（p=0.011）和系统治疗类型（p=0.003）与 FPP 显著相关。在 SBRT 后，29 例（54.72%）患者进行了系统治疗的转换或强化，中位 NEST-FS 为 15.2 个月。1 年和 2 年的 LC 分别为 94.0%和 92.0%，PSA 倍增时间与 LC 显著相关（p=0.047）。中位 DPFS 为 8.93 个月，中位 OS 为 50.6 个月。总之，我们证实了 SBRT 治疗 PC 寡进展的疗效，有可能延长正在进行的系统治疗并中断转移级联。
