Xu Chenyang, Zhao Xianzhi, Ju Xiaoping, Shen Yuxin, Qu Min, Ye Yusheng, Wang Xiaoyan, Yu Chunshan, Gao Xu, Zhang Huojun
Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.
Department of Radiation Oncology, Shanghai Changhai Hospital, The Navy Medical University, Shanghai, China.
Front Oncol. 2022 Apr 28;12:879310. doi: 10.3389/fonc.2022.879310. eCollection 2022.
To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) in managing oligometastases of prostate cancer. Moreover, it is the largest-to-date study in China to report the safety and efficacy of SBRT by CyberKnife for oligometastases of prostate cancer.
In this retrospective study, 75 patients with 108 oligometastases were treated by SBRT from May 2012 to February 2021. Among these patients, 43 patients were treated with the intention to control all known metastatic lesions and 32 were treated for palliative care. Patients received regular follow-up evaluations every 3 months. Efficacy was assessed based on local control (LC) rates, biochemical progression-free survival (bPFS), progression-free survival (PFS), and overall survival (OS). Safety was assessed based on clinical adverse events.
Median follow-up time was 23.2 months (1.2-106.9 months). The complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) rates were 63.0%, 10.2%, 21.3% and 5.6%, respectively. The 6-month, 1-, and 2-year LC rates were 100%, 97.5%, and 96.0% respectively while the 6-month, 1-, and 2-year bPFS rates were 74.6%, 53.3%, and 47.9%, respectively. Additionally, 6-month, 1-, and 2-year PFS rates were 77.5%, 50.8%, and 47.2%, respectively. The 6-month, 1-, and 2-year OS rates were 97.0%, 88.8%, and 87.0%, respectively. For the 15 metastatic castration-resistant prostate cancer (mCRPC) patients with 23 lesions, the 2-year LC rates were 93.8%, while for 60 metastatic hormone-sensitive prostate cancer (mHSPC) patients with 85 lesions, the 2-year LC rates were 96.7%. No predictors of LC were found after univariate analysis. In those not on androgen deprivation therapy (ADT; n = 27), the 2-year freedom from ADT was 44.0%. All of the 24 patients with oligmetastase-induced complications experienced varying degrees of alleviation after SBRT. The treatment was well tolerated. No grade 3 or higher toxicity was observed.
SBRT is a safe and effective treatment modality in the management of oligometastases of mHSPC and mCRPC with high LC rates and acceptable toxicity. SBRT could provide a treatment choice for mCRPC, as well as an alternative to delay the start of ADT for mHSPC.
评估立体定向体部放射治疗（SBRT）在治疗前列腺癌寡转移中的疗效和安全性。此外，这是中国迄今为止最大规模的关于射波刀SBRT治疗前列腺癌寡转移安全性和疗效的研究。
在这项回顾性研究中，2012年5月至2021年2月期间，75例患者的108处寡转移灶接受了SBRT治疗。其中，43例患者旨在控制所有已知转移灶，32例接受姑息治疗。患者每3个月接受一次定期随访评估。疗效基于局部控制（LC）率、生化无进展生存期（bPFS）、无进展生存期（PFS）和总生存期（OS）进行评估。安全性基于临床不良事件进行评估。
中位随访时间为23.2个月（1.2 - 106.9个月）。完全缓解（CR）、部分缓解（PR）、疾病稳定（SD）和疾病进展（PD）率分别为63.0%、10.2%、21.3%和5.6%。6个月、1年和2年的LC率分别为100%、97.5%和96.0%，而6个月、1年和2年的bPFS率分别为74.6%、53.3%和47.9%。此外，6个月、1年和2年的PFS率分别为77.5%、50.8%和47.2%。6个月、1年和2年的OS率分别为97.0%、88.8%和87.0%。对于15例有23处转移灶的去势抵抗性前列腺癌（mCRPC）患者，2年LC率为93.8%，而对于60例有85处转移灶的激素敏感性前列腺癌（mHSPC）患者，2年LC率为96.7%。单因素分析后未发现LC的预测因素。在未接受雄激素剥夺治疗（ADT；n = 27）的患者中，2年无ADT率为44.0%。24例发生寡转移相关并发症的患者在SBRT后均有不同程度的缓解。该治疗耐受性良好。未观察到3级或更高等级的毒性反应。
SBRT是一种安全有效的治疗方式，可用于治疗mHSPC和mCRPC的寡转移，LC率高且毒性可接受。SBRT可为mCRPC提供一种治疗选择，也可作为mHSPC延迟开始ADT的替代方案。
