Francolini Giulio, Garlatti Pietro, Di Cataldo Vanessa, Triggiani Luca, Simoni Nicola, Detti Beatrice, Lorenzetti Victoria, Colombo Federico, Morelli Vittorio, Ganovelli Michele, Caprara Luisa, Orsatti Carolina, Burchini Luca, Frosini Giulio, Bertini Niccolò, Loi Mauro, Simontacchi Gabriele, Greto Daniela, Desideri Isacco, Meattini Icro, Livi Lorenzo
Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.
Radiol Med. 2023 Nov;128(11):1423-1428. doi: 10.1007/s11547-023-01701-x. Epub 2023 Aug 19.
M1a disease represents an intermediate status between loco-regional relapse and bone metastatic disease. Metastasis directed therapy (MDT), through stereotactic body RT (SBRT) may be offered to patients, aiming to exclusively treat sites of macroscopic relapse and avoiding wide prophylactic treatment volumes. This appears as a viable treatment, especially after the rise of PSMA tailored treatment approaches.
Data about patients treated in two different institutions were retrieved from a prospectively collected dataset. All included patients were affected by oligo-recurrent M1a disease after definitive RT or radical prostatectomy, defined as ≤ 3 nodal lesions situated above aortic bifurcation and below renal arteries. Both castration resistant PCa (CRPC) and castration sensitive (CSPC) PCa patients were included. All imaging methods were allowed to detect recurrence (CT scan, Choline or PSMA PET/CT).All sites of recurrences were treated with SBRT.
Median PFS was 10 months (95% CI 8-17). Twelve patients died, with a median OS of 114 months (95% CI 85-114). Out of the 83 recurrences, 2 (2.4%), 11 (13.25%), 36 (43.37%) and 15 (18%) patients had respectively prostate bed only, pelvic nodal, para-aortic or distant relapse. Furthermore, 19 (22.9%) patients experienced a biochemical only relapse with negative imaging at re-staging.
MDT conferred a remarkable PFS outcome in a mixed cohort of CSPC and CRPC patients with m1a disease, with an optimal safety profile. Prospective trials are needed in order to compare MDT and ENRT for these patients, allowing to select the best treatment option.
M1a期疾病代表局部区域复发和骨转移疾病之间的中间状态。对于患者，可以采用转移导向治疗（MDT），通过立体定向体部放疗（SBRT），旨在专门治疗宏观复发部位并避免广泛的预防性治疗体积。这似乎是一种可行的治疗方法，尤其是在PSMA定制治疗方法兴起之后。
从一个前瞻性收集的数据集中检索了在两个不同机构接受治疗的患者的数据。所有纳入的患者在确定性放疗或根治性前列腺切除术后患有寡复发M1a期疾病，定义为主动脉分叉上方和肾动脉下方≤3个淋巴结病变。去势抵抗性前列腺癌（CRPC）和去势敏感性前列腺癌（CSPC）患者均包括在内。允许使用所有成像方法检测复发（CT扫描、胆碱或PSMA PET/CT）。所有复发部位均接受SBRT治疗。
中位无进展生存期为10个月（95%CI 8-17）。12例患者死亡，中位总生存期为114个月（95%CI 85-114）。在83例复发患者中，分别有2例（2.4%）、11例（13.25%）、36例（43.37%）和15例（18%）患者仅出现前列腺床、盆腔淋巴结、腹主动脉旁或远处复发。此外，19例（22.9%）患者在重新分期时仅出现生化复发且影像学检查为阴性。
MDT在患有m1a期疾病的CSPC和CRPC患者的混合队列中带来了显著的无进展生存期结果，且安全性良好。需要进行前瞻性试验以比较MDT和ENRT对这些患者的疗效，从而选择最佳治疗方案。
