以转移灶定向放疗作为单一治疗方式治疗前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描检测到的寡转移前列腺癌患者的肿瘤学结局
Oncological Outcomes in Patients with Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography-detected Oligometastatic Prostate Cancer Treated with Metastasis-directed Radiotherapy as the Single Treatment Modality.
作者信息
de Bie Katelijne C C, Zuur Lotte G, Meijer Dennie, Meijnen Philip, Hinnen Karel A, Oprea-Lager Daniela E, van Leeuwen Pim J, Vis Andre N
机构信息
Department of Urology, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands.
出版信息
Eur Urol Oncol. 2025 Apr 26. doi: 10.1016/j.euo.2025.04.002.
BACKGROUND AND OBJECTIVE
In patients with biochemical recurrence (BCR), prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) can detect oligometastatic prostate cancer (PCa). However, the optimal treatment approach for oligometastatic disease remains unclear. This study aims to assess the oncological outcomes of metachronous oligometastatic PCa patients treated with metastasis-directed radiotherapy (MDRT).
METHODS
We retrospectively evaluated patients with hormone-sensitive, metachronous oligometastatic PCa who underwent MDRT for BCR (from July 2012 to September 2022). Patients had one to four lymph nodes and/or bone metastases on PSMA PET/CT and were irradiated with 5 × 7 or 3 × 10 Gy. The biochemical response to MDRT was assessed as undetectable prostate-specific antigen (PSA) at follow-up, PSA response (PSA ≤ pretreatment level), or biochemical progression (PSA > pretreatment level). Biochemical progression-free survival (bPFS) and local remission of disease (absence of disease at the MDRT site on follow-up PSMA PET/CT or undetectable PSA) were evaluated.
KEY FINDINGS AND LIMITATIONS
Eighty patients underwent MDRT for 105 PSMA PET/CT-confirmed lesions. The median time from curative treatment to MDRT was 55 mo (interquartile range [IQR] 31-103). At a median follow-up of 32 mo after MDRT (IQR 21-64), 10% of the patients were PSA free, 10% had a PSA response, and 80% experienced biochemical progression. The bPFS rates at 1 and 2 yr were 54% and 38%, respectively. A total of 87% of patients had local control of disease after MDRT, whereas 72% had new metastatic lesions on repeated PSMA PET/CT. Limitations include the retrospective design and a small cohort.
CONCLUSIONS AND CLINICAL IMPLICATIONS
MDRT for oligometastatic disease shows high local efficacy. However, disease progression is observed in a substantial proportion of patients.
背景与目的
在生化复发（BCR）的患者中，前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）能够检测出寡转移前列腺癌（PCa）。然而，寡转移疾病的最佳治疗方法仍不明确。本研究旨在评估接受转移灶定向放疗（MDRT）的异时性寡转移PCa患者的肿瘤学结局。
方法
我们回顾性评估了因BCR接受MDRT的激素敏感性、异时性寡转移PCa患者（2012年7月至2022年9月）。患者在PSMA PET/CT上有1至4个淋巴结和/或骨转移灶，并接受了5×7或3×10 Gy的照射。将对MDRT的生化反应评估为随访时前列腺特异性抗原（PSA）不可检测、PSA反应（PSA≤治疗前水平）或生化进展（PSA>治疗前水平）。评估生化无进展生存期（bPFS）和疾病局部缓解情况（随访PSMA PET/CT时MDRT部位无疾病或PSA不可检测）。
主要发现与局限性
80例患者因105个PSMA PET/CT确诊的病灶接受了MDRT。从根治性治疗到MDRT的中位时间为55个月（四分位间距[IQR] 31 - 103）。在MDRT后的中位随访32个月（IQR 21 - 64）时，10%的患者PSA转阴，10%有PSA反应，80%出现生化进展。1年和2年的bPFS率分别为54%和38%。共有87%的患者在MDRT后疾病得到局部控制，而72%的患者在重复PSMA PET/CT时有新的转移病灶。局限性包括回顾性设计和样本量小。
结论与临床意义
寡转移疾病的MDRT显示出较高的局部疗效。然而，相当一部分患者出现疾病进展。
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