PSMA PET 检测到寡转移前列腺癌的 SBRT 长期结果。
Long-term outcomes of SBRT for PSMA PET detected oligometastatic prostate cancer.
机构信息
Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia.
出版信息
Radiat Oncol. 2023 Aug 1;18(1):127. doi: 10.1186/s13014-023-02302-8.
BACKGROUND
Oligometastatic disease in prostate cancer (PCa) is a challenging clinical scenario encountered more frequently with the widespread adoption of PSMA-PET. SBRT aims to defer androgen deprivation and may deliver sustained biochemical failure (BF) free survival in selected patients. Little long-term data is currently available regarding the effectiveness of this approach.
METHODS
A retrospective single institution study of PSMA-PET directed SBRT without initial ADT for oligo-metachronous PCa. Median dose/fractionation was 24 Gy in 2# to bones and 30 Gy in 3# to lymph nodes. The primary endpoint was time to BF (PSA + 0.2 ug/L above nadir). Secondary endpoints included time to ADT for relapse (i.e. palliative ADT), BF defined as PSA nadir + 2 ug/L, toxicity, patterns of failure and survival. Patients were excluded if they received ADT with their SBRT, had short disease-free interval, or > 3 metastases on PSMA-PET.
RESULTS
103 patients treated from November-2014 to December-2019 were analysed from our prospective database. Median follow-up was 5 years. 64 patients were treated for nodal only disease, 35 bone only and 4 mixed. 15% were free of any BF at 5 years with median time to BF of 1.1 years. 32% (33/103) of patients had further curative-intent radiation treatment following their first BF after SBRT, including subsequent SBRT. Eight patients underwent potentially curative treatment for their second or third relapse. Allowing for salvage treatment, 29/103 (28%) were biochemically disease free at last follow up. At 5 years, 39% of patients had never received any ADT and 55% had not started ADT for relapse with a median time to ADT for relapse of 5.5 years. There were 2 grade 3 toxicities (rib fracture and lymphoedema), and no local failures.
CONCLUSION
PSMA-PET guided SBRT for oligo-metachronous PCa recurrence in appropriately triaged patients results in excellent local control, low toxicity and over 50% ADT free at 5 years.
背景
前列腺癌（PCa）寡转移疾病是一种具有挑战性的临床情况，随着 PSMA-PET 的广泛应用，这种情况更为常见。SBRT 的目的是推迟雄激素剥夺治疗，并可能为选定的患者提供持续的生化无失败（BF）生存。目前关于这种方法的有效性的长期数据很少。
方法
回顾性单机构研究，对寡转移性 PCa 进行 PSMA-PET 引导的 SBRT，不进行初始 ADT。中位剂量/分割为骨骼 24Gy/2#，淋巴结 30Gy/3#。主要终点是 BF 时间（PSA 比最低点升高 0.2ug/L 以上）。次要终点包括因复发而接受 ADT 的时间（即姑息性 ADT）、BF 定义为 PSA 最低点+2ug/L、毒性、失败模式和生存。如果患者在 SBRT 期间接受 ADT、无疾病间隔短或 PSMA-PET 上有>3 个转移灶，则将其排除在外。
结果
从我们的前瞻性数据库中分析了 2014 年 11 月至 2019 年 12 月期间治疗的 103 例患者。中位随访时间为 5 年。64 例患者为淋巴结疾病，35 例为骨疾病，4 例为混合疾病。5 年内有 15%的患者无任何 BF，BF 中位时间为 1.1 年。32%（33/103）的患者在 SBRT 后的首次 BF 后接受了进一步的根治性放射治疗，包括随后的 SBRT。8 例患者因第二次或第三次复发接受了潜在的根治性治疗。允许挽救性治疗，103 例患者中有 29 例（28%）在最后一次随访时无生化疾病。5 年内，39%的患者从未接受过任何 ADT，55%的患者因复发未开始 ADT，ADT 用于复发的中位时间为 5.5 年。有 2 例 3 级毒性（肋骨骨折和淋巴水肿），无局部失败。
结论
在适当分层的患者中，PSMA-PET 引导的寡转移性 PCa 复发的 SBRT 可获得出色的局部控制效果，毒性低，5 年内超过 50%的患者无需 ADT。
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