Koh Min Ji, Pilkington Padraig, Koh Min Jung, Lawlor Mary-Kate, Creswell Michael, O'Connor Timothy, Zwart Alan, Danner Malika, Kumar Deepak, Suy Simeng, Carrasquilla Michael, Collins Sean P
Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States.
Department of Urology, The University of Kansas Health System, Kansas City, KS, United States.
Front Oncol. 2024 Oct 17;14:1434504. doi: 10.3389/fonc.2024.1434504. eCollection 2024.
Following treatment for localized prostate cancer, a subset of men will develop recurrent disease in the abdominopelvic nodes. For radiation therapy (RT), the optimal treatment volume, fractionation schedule, and dose remain unanswered questions. We report early outcomes for patients treated with involved-field stereotactic body radiation therapy (SBRT) (IF-SBRT) for nodal oligo-recurrent (NOR) prostate cancer.
Between January 2018 and October 2023, 67 patients with a median age of 75 with NOR prostate cancer treated with 74 courses of IF-SBRT at Georgetown were eligible for this analysis. NOR was defined as any volume of disease that could be safely treated within an IF. All patients were treated with five-fraction IF-SBRT (27.5-35 Gy). The IF treatment volume was defined as the nodal basin containing the gross disease as well as the immediately adjacent basins. Disease progression was defined as a prostate-specific antigen (PSA) rise above the pretreatment baseline or initiation of a second treatment. Local control and progression-free survival were calculated using the Kaplan-Meier method.
Detection of pre-SBRT NOR was ascertained by prostate-specific membrane antigen (PSMA) (38%), fluciclovine (50%), or MRI/CT (12%). Median follow-up was 50 months (1-262). The median pre-salvage PSA was 6.5 ng/mL (range, 0.1-335). The median number of involved nodes was 3 (range, 1-16). The local control at 1 and 2 years was 98% and 93%, respectively. The 1- and 2-year progression-free survival was 78% and 50%, respectively. Twenty percent of treatment courses were followed by acute Grade 2 gastrointestinal (GI) toxicity: diarrhea (9%) and/or nausea (14%). Two patients (3%) experienced late Grade 2 nausea. On univariate analysis, measures of disease volume such as hormone sensitivity ( = 0.03), increasing involved node number ( = 0.008), and abdominal treatment ( = 0.03) were significantly associated with GI toxicity.
With the widespread adoption of PSMA agents, NORs are likely to increase. The optimal combination of local and systemic therapy in this population is unknown. With a favorable toxicity profile, IF-SBRT represents a safe and convenient local therapy treatment option for an elderly patient population. Patient- and treatment-related factors such as a large number of involved nodes and/or abdominal treatment may be associated with an increased risk of GI toxicity.
在局部前列腺癌接受治疗后，一部分男性会在腹盆腔淋巴结出现复发性疾病。对于放射治疗（RT），最佳治疗体积、分割方案和剂量仍是尚未解决的问题。我们报告了接受累及野立体定向体部放射治疗（SBRT）（IF-SBRT）的寡转移复发性（NOR）前列腺癌患者的早期结果。
在2018年1月至2023年10月期间，67例中位年龄为75岁的NOR前列腺癌患者在乔治敦接受了74个疗程的IF-SBRT治疗，符合本分析标准。NOR定义为可在累及野内安全治疗的任何疾病体积。所有患者均接受五分割IF-SBRT（27.5 - 35 Gy）治疗。累及野治疗体积定义为包含大体疾病的淋巴结区域以及紧邻的区域。疾病进展定义为前列腺特异性抗原（PSA）升高超过治疗前基线或开始第二次治疗。采用Kaplan-Meier方法计算局部控制率和无进展生存率。
SBRT前NOR的检测通过前列腺特异性膜抗原（PSMA）（38%）、氟代脱氧葡萄糖（50%）或MRI/CT（12%）确定。中位随访时间为50个月（1 - 262个月）。挽救前PSA中位数为6.5 ng/mL（范围0.1 - 335）。受累淋巴结中位数为3个（范围1 - 16个）。1年和2年的局部控制率分别为98%和93%。1年和2年的无进展生存率分别为78%和50%。20%的治疗疗程出现急性2级胃肠道（GI）毒性：腹泻（9%）和/或恶心（14%）。2例患者（3%）出现晚期2级恶心。单因素分析显示，疾病体积指标如激素敏感性（P = 0.03）、受累淋巴结数量增加（P = 0.008）和腹部治疗（P = 0.03）与GI毒性显著相关。
随着PSMA药物的广泛应用，NOR可能会增加。该人群中局部和全身治疗的最佳组合尚不清楚。IF-SBRT毒性特征良好，是老年患者群体安全便捷的局部治疗选择。大量受累淋巴结和/或腹部治疗等患者及治疗相关因素可能与GI毒性风险增加有关。
