Francolini Giulio, Bertini Niccolò, Di Cataldo Vanessa, Garlatti Pietro, Aquilano Michele, Caini Saverio, Bruni Alessio, Ingrosso Gianluca, D'angelillo Rolando Maria, Tagliaferri Luca, Augugliaro Matteo, Triggiani Luca, Parisi Silvana, Timon Giorgia, Arcidiacono Fabio, Marvaso Giulia, Jereczek-Fossa Barbara Alicja, Lancia Andrea, Franzese Ciro, Alongi Filippo, Simontacchi Gabriele, Greto Daniela, Bonomo Pierluigi, Loi Mauro, Frosini Giulio, Burchini Luca, Desideri Isacco, Meattini Icro, Valicenti Richard K, Livi Lorenzo
Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy.
Department of Biomedical, Experimental and Clinical sciences "Mario Serio", University of Florence, Florence, Italy.
Prostate Cancer Prostatic Dis. 2025 Feb 19. doi: 10.1038/s41391-025-00950-3.
ARTO trial was a phase II randomized trial suggesting the benefit of a concomitant treatment strategy including Abiraterone acetate plus predisone (AAP) and stereotactic body radiotherapy (SBRT) in oligometastatic castrate resistant prostate cancer (omCRPC). The object of the current analysis is to explore whether the benefit provided by SBRT to AAP is maintained at later stages of disease after oligoprogression METHODS: Patients enrolled in ARTO trial in whom a first progression event was reported were divided in two groups according to the treatment approach received, regardless of the initial randomization. After first progression event, Patients in Group A received SBRT on oligoprogressive disease, while patients in group B received second line systemic treatment. Palliative RT was not considered for the purpose of this analysis. Progression-Free survival (PFS) 1 and 2 were defined as time between AAP start and first progression event and time between first and second progression event, death or last follow up, (whichever came first), respectively. Cox regression analysis was performed to compare PFS1 + PFS2 in patients in group A vs Group B. Kaplan-Meier analysis was performed to compare overall survival between the two groups RESULTS: Median PFS1 + PFS2 was 45.9 months vs. not reached in group A (n = 43) vs Group B (n = 20), respectively (HR 0.63, 95% CI 0.17-2.33, p value 0.489), no significant difference was detected. Median OS was not reached in neither of the two arms of treatment, with a non-significant trend in favour of the experimental arm (HR 0.50, 95% CI 0.14-1.78, p = 0.284) CONCLUSIONS: Results from the present analysis show that SBRT after progression may be a viable and feasible option for omCRPC after progression if compared to second line systemic therapy.
ARTO试验是一项II期随机试验，表明醋酸阿比特龙加泼尼松（AAP）和立体定向体部放疗（SBRT）联合治疗策略对寡转移去势抵抗性前列腺癌（omCRPC）有益。本分析的目的是探讨在寡进展后疾病的后期阶段，SBRT对AAP的益处是否得以维持。方法：将参加ARTO试验且报告了首次进展事件的患者，根据所接受的治疗方法分为两组，而不考虑最初的随机分组情况。首次进展事件发生后，A组患者对寡进展性疾病接受SBRT治疗，而B组患者接受二线全身治疗。本分析不考虑姑息性放疗。无进展生存期（PFS）1和2分别定义为从开始使用AAP到首次进展事件的时间以及从首次进展到第二次进展事件、死亡或最后一次随访（以先发生者为准）的时间。进行Cox回归分析以比较A组和B组患者的PFS1 + PFS2。进行Kaplan-Meier分析以比较两组之间的总生存期。结果：A组（n = 43）和B组（n = 20）的PFS1 + PFS2中位数分别为45.9个月和未达到（HR 0.63，95% CI 0.17 - 2.33，p值0.489），未检测到显著差异。两个治疗组的总生存期均未达到，支持试验组的趋势不显著（HR 0.50，95% CI 0.14 - 1.78，p = 0.284）。结论：本分析结果表明，与二线全身治疗相比，进展后使用SBRT可能是omCRPC进展后一种可行的选择。
