Department of Radiation Oncology, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, DE, Germany.
Department of Radiation Oncology, Medical University of Graz, 8036, Graz, Austria.
J Cancer Res Clin Oncol. 2023 Jul;149(7):3937-3949. doi: 10.1007/s00432-022-04229-1. Epub 2022 Aug 27.
Oligometastatic prostate cancer is heavily investigated, and conventionally fractionated elective nodal treatment appears to increase biochemical relapse-free (bRFS) survival. The novelty of this report is to present elective nodal radiotherapy (ENRT) with simultaneous integrated boost with stereotactic (SBRT) or hypofractionated radiotherapy (HoFRT) for tolerance and for bRFS which we compared with SBRT of the involved field (IF) only.
Patients between 2018 and 2021 with and oligometastatic prostate cancer treated with SBRT or hypofractionation were eligible. A radiobiologically calculated simultaneous integrated boost approach enabled to encompass elective nodal radiotherapy (ENRT) with high doses to PSMA-positive nodes. A second group had only involved field (IF) nodal SBRT.
A total of 44 patients with 80 lesions of initially intermediate- (52%) or high-risk (48%) D'Amico omPC were treated with SBRT to all visible PSMA-PET/CT lesions and 100% of the treated lesions were locally controlled after a median follow-up was 18 months (range 3-42 months). Most lesions (56/80; 70%) were nodal and the remainder osseous. Median bPFS was 16 months and ADT-free bPFS 18 months. ENRT (31 patients) versus IF (13 patients) prevented regional relapse more successfully. At univariate analysis, both initial PSA and length of the interval between primary diagnosis and biochemical failure were significant for biochemical control. Treatment was well tolerated and only two patients had toxicity ≥ grade 3 (1 GU and 1 GI, each).
DISCUSSION/CONCLUSION: SBRT and hypofractionated radiotherapy at curative doses with ENRT was more effective to delay ADT than IF, controlled all treated lesions and was well tolerated.
寡转移前列腺癌受到广泛研究，传统的分次选择性淋巴结治疗似乎能提高生化无复发生存（bRFS）。本报告的新颖之处在于，提出了立体定向放疗（SBRT）或适形低分割放疗（HoFRT）同步整合增敏的选择性淋巴结放疗（ENRT），并将其与单纯累及野（IF）SBRT 的 bRFS 进行比较。
2018 年至 2021 年间，我们对寡转移前列腺癌患者进行了 SBRT 或适形低分割放疗，符合条件的患者纳入本研究。采用放射生物学计算的同步整合增敏方法，实现了对 PSMA 阳性淋巴结的高剂量 ENRT。另一组患者仅接受了 IF 淋巴结 SBRT。
共有 44 例患者，80 个病灶，初诊时为中危（52%）或高危（48%）D'Amico 局部晚期前列腺癌，接受了 SBRT 治疗所有可见的 PSMA-PET/CT 病灶，中位随访 18 个月（范围 3-42 个月）后，所有治疗病灶均局部控制。大多数病灶（56/80；70%）为淋巴结转移，其余为骨转移。中位 bPFS 为 16 个月，无 ADT 生存 bPFS 为 18 个月。ENRT（31 例）比 IF（13 例）更能成功预防区域性复发。单因素分析显示，初诊 PSA 和生化失败与原发诊断之间的间隔长度对生化控制均有显著影响。治疗耐受性良好，仅有 2 例患者出现毒性反应≥3 级（1 例为 GU，1 例为 GI）。
讨论/结论：ENRT 联合 SBRT 和 HoFRT 以根治性剂量治疗，延迟 ADT 的效果优于 IF，控制了所有治疗病灶，且耐受性良好。
