Fiorica Francesco, Sava Teodoro, Giuliani Jacopo, Tebano Umberto, Napoli Giuseppe, Franceschetto Antonella, Durante Emilia, Campisi Ilaria, Palesandro Erica, Turco Fabio, Buttigliero Consuelo, Munoz Fernando, Tucci Marcello
Department of Clinical Oncology, Section of Radiation Oncology and Nuclear Medicine, AULSS 9 Scaligera, 37122 Verona, Italy.
Department of Clinical Oncology, Section of Medical Oncology, AULSS 9 Scaligera, 37045 Legnago, Italy.
Cancers (Basel). 2025 Apr 8;17(8):1256. doi: 10.3390/cancers17081256.
Metastasis-directed therapy (MDT) alone may be effective in preventing disease progression and positively affecting overall survival (OS) in oligometastatic prostate cancer (OMPC).
We systematically reviewed the current literature to analyse the biological rationale for integrating MDT into treatment strategies for OMPC and investigate the current evidence on its role in OMPC.
MEDLINE/PUBMED and the EMBASE Database were systematically searched to identify eligible reports published up to January 2024. The proceedings of the European Society for Radiotherapy and Oncology, European Society of Medical Oncology, American Society for Radiation Oncology, American Society of Clinical Oncology, European Uro-Oncology Group, and American Urological Association annual meetings were analysed.
Eighteen studies published between 2014 and 2024 were selected for the analysis. The studies included 1058 patients treated with metastasis-directed radiotherapy. No statistically significant differences were found in terms of treatment-escalation-free survival between hormone-naïve patients treated with MDT alone and those treated with MDT and hormonal manipulation. By contrast, the combination treatment significantly increased both 2 year and 4 year disease-progression-free survival (DPFS) rates (-values < 0.00001 and 0.006, respectively). In patients with castration-sensitive disease treated with MDT alone, the estimated 2 year and 4 year OS rates were 96.4% (95% confidence interval [CI], 92.9-100%) and 89.1% (95% CI, 82.3-96.5%), respectively. The estimated 2 year and 4 year overall survival rates in the combination treatment group were 86.1% (95% CI 79.2-93.7%) and 74.8% (95% CI 64.6.3-86.5%), respectively.
MDT alone is associated with promising outcomes in OMPC and represents a valuable, valid, and often preferable strategy. Combined with ADT improves significantly disease-progression-free survival, but its impact on overall survival remains uncertain. Given these findings, the decision to incorporate ADT should be tailored to individual patient characteristics and clinical context. Future research should integrate biomarker-based approaches to optimise MDT use and select the best candidates for a multimodal approach.
单独的转移灶导向治疗（MDT）可能有效预防寡转移前列腺癌（OMPC）的疾病进展并对总生存期（OS）产生积极影响。
我们系统回顾了当前文献，以分析将MDT纳入OMPC治疗策略的生物学原理，并调查其在OMPC中作用的现有证据。
系统检索MEDLINE/PUBMED和EMBASE数据库，以识别截至2024年1月发表的符合条件的报告。分析了欧洲放射肿瘤学会、欧洲医学肿瘤学会、美国放射肿瘤学会、美国临床肿瘤学会、欧洲泌尿肿瘤学组和美国泌尿外科学会年会的会议记录。
选择了2014年至2024年间发表的18项研究进行分析。这些研究包括1058例接受转移灶导向放疗的患者。在单纯接受MDT治疗的初治患者与接受MDT和激素治疗的患者之间，无治疗升级生存期方面未发现统计学显著差异。相比之下，联合治疗显著提高了2年和4年无疾病进展生存期（DPFS）率（P值分别<0.00001和0.006）。在单纯接受MDT治疗的去势敏感疾病患者中，估计2年和4年OS率分别为96.4%（95%置信区间[CI]，92.9 - 100%）和89.1%（95%CI，82.3 - 96.5%）。联合治疗组的估计2年和4年总生存率分别为86.1%（95%CI 79.2 - 93.7%）和74.8%（95%CI 64.6 - 86.5%）。
单独的MDT在OMPC中具有良好的预后，是一种有价值、有效的且通常更可取的策略。与雄激素剥夺治疗（ADT）联合可显著提高无疾病进展生存期，但其对总生存期的影响仍不确定。鉴于这些发现，是否纳入ADT的决定应根据个体患者特征和临床情况量身定制。未来的研究应整合基于生物标志物的方法，以优化MDT的使用并选择多模式治疗的最佳候选者。
