Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland.
Eur Urol. 2024 Feb;85(2):125-138. doi: 10.1016/j.eururo.2023.10.012. Epub 2023 Nov 7.
Despite the lack of level 1 evidence, metastasis-directed therapy (MDT) is used widely in the management of metastatic prostate cancer (mPCa) patients. Data are continuously emerging from well-designed prospective studies.
To summarise and report the evidence on oncological and safety outcomes of MDT in the management of mPCa patients.
We searched the PubMed, Scopus, and Web of Science databases for prospective studies assessing progression-free survival (PFS), local control (LC), androgen deprivation therapy (ADT)-free survival (ADT-FS), overall survival (OS), and/or adverse events (AEs) in mPCa patients treated with MDT. A meta-analysis was performed for 1- and 2-yr PFS, LC, ADT-FS, OS, and rate of AEs. Meta-regression and sensitivity analysis were performed to account for heterogeneity and identify moderators.
We identified 22 prospective studies (n = 1137), including two randomised controlled trials (n = 116). Two studies were excluded from the meta-analysis (n = 120). The estimated 2-yr PFS was 46% (95% confidence interval [CI]: 36-56%) or 42% (95% CI: 33-52%) after excluding studies using biochemical or ADT-related endpoints. The estimated 2-yr LC, ADT-FS, and OS were 97% (95% CI: 94-98%), 55% (95% CI: 44-65%), and 97% (95% CI: 95-98%), respectively. Rates of treatment-related grade 2 and ≥3 AEs were 2.4% (95% CI: 0.2-7%) and 0.3% (95% CI: 0-1%), respectively.
MDT is a promising treatment strategy associated with favourable PFS, excellent LC, and a low toxicity profile that allows oligorecurrent hormone-sensitive patients to avoid or defer ADT-related toxicity. Integration of MDT with other therapies offers a promising research direction, in particular, in conjunction with systemic treatments and as a component of definitive care for oligometastatic PCa. However, in the absence of randomised trials, using MDT for treatment intensification remains an experimental approach, and the impact on OS is uncertain.
Direct treatment of metastases is a promising option for selected prostate cancer patients. It can delay hormone therapy and is being investigated as a way of intensifying treatment at the expense of manageable toxicity.
尽管缺乏一级证据，但转移导向治疗（MDT）在转移性前列腺癌（mPCa）患者的管理中得到了广泛应用。不断有来自精心设计的前瞻性研究的数据涌现。
总结并报告 MDT 治疗 mPCa 患者的肿瘤学和安全性结局的证据。
我们在 PubMed、Scopus 和 Web of Science 数据库中搜索了评估无进展生存（PFS）、局部控制（LC）、去势治疗（ADT）无进展生存（ADT-FS）、总生存（OS）和/或 mPCa 患者 MDT 治疗相关不良事件（AE）的前瞻性研究。对 1 年和 2 年的 PFS、LC、ADT-FS、OS 和 AE 发生率进行了荟萃分析。进行了荟萃回归和敏感性分析，以解释异质性并确定调节因素。
我们确定了 22 项前瞻性研究（n=1137），其中包括两项随机对照试验（n=116）。有两项研究（n=120）被排除在荟萃分析之外。排除使用生化或 ADT 相关终点的研究后，估计 2 年 PFS 为 46%（95%置信区间[CI]：36-56%）或 42%（95% CI：33-52%）。估计 2 年 LC、ADT-FS 和 OS 分别为 97%（95% CI：94-98%）、55%（95% CI：44-65%）和 97%（95% CI：95-98%）。与治疗相关的 2 级和≥3 级 AE 发生率分别为 2.4%（95% CI：0.2-7%）和 0.3%（95% CI：0-1%）。
MDT 是一种很有前途的治疗策略，与良好的 PFS、卓越的 LC 和低毒性特征相关，使寡复发激素敏感患者能够避免或推迟 ADT 相关毒性。MDT 与其他治疗方法的整合提供了一个很有前途的研究方向，特别是与系统治疗相结合，以及作为寡转移 PCa 确定性治疗的一部分。然而，由于缺乏随机试验，使用 MDT 进行治疗强化仍然是一种实验性方法，其对 OS 的影响尚不确定。
直接治疗转移是一种有前途的选择，适用于特定的前列腺癌患者。它可以延迟激素治疗，并且正在研究作为一种强化治疗的方法，代价是可管理的毒性。
