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Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience

Background: The favorable role of SBRT for lymph-nodal oligometastases from prostate cancer has been reported by several retrospective and prospective experiences, suggesting a more indolent natural history of disease when compared to patients with bone oligometastases. This retrospective multicente...

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Autores principales: Cuccia, Francesco, Tamburo, Maria, Piras, Antonio, Mortellaro, Gianluca, Iudica, Arianna, Daidone, Antonino, Federico, Manuela, Zagardo, Valentina, Ferini, Gianluca, Marletta, Francesco, Spatola, Corrado, Fazio, Ivan, Filosto, Sergio, Pergolizzi, Stefano, Ferrera, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456704/
https://www.ncbi.nlm.nih.gov/pubmed/37629732
http://dx.doi.org/10.3390/medicina59081442
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author Cuccia, Francesco
Tamburo, Maria
Piras, Antonio
Mortellaro, Gianluca
Iudica, Arianna
Daidone, Antonino
Federico, Manuela
Zagardo, Valentina
Ferini, Gianluca
Marletta, Francesco
Spatola, Corrado
Fazio, Ivan
Filosto, Sergio
Pergolizzi, Stefano
Ferrera, Giuseppe
author_facet Cuccia, Francesco
Tamburo, Maria
Piras, Antonio
Mortellaro, Gianluca
Iudica, Arianna
Daidone, Antonino
Federico, Manuela
Zagardo, Valentina
Ferini, Gianluca
Marletta, Francesco
Spatola, Corrado
Fazio, Ivan
Filosto, Sergio
Pergolizzi, Stefano
Ferrera, Giuseppe
author_sort Cuccia, Francesco
collection PubMed
description Background: The favorable role of SBRT for lymph-nodal oligometastases from prostate cancer has been reported by several retrospective and prospective experiences, suggesting a more indolent natural history of disease when compared to patients with bone oligometastases. This retrospective multicenter study evaluates the outcomes of a cohort of patients treated with stereotactic body radiotherapy for lymph-nodal oligometastases. Methods: Inclusion criteria were up to five lymph-nodal oligometastases detected either with Choline-PET or PSMA-PET in patients naïve for ADT or already ongoing with systemic therapy and at least 6 Gy per fraction for SBRT. Only patients with exclusive lymph-nodal disease were included. The primary endpoint of the study was LC; a toxicity assessment was retrospectively performed following CTCAE v4.0. Results: A total of 100 lymph-nodal oligometastases in 69 patients have been treated with SBRT between April 2015 and November 2022. The median age was 73 years (range, 60–85). Oligometastatic disease was mainly detected with Choline-PET in 47 cases, while the remaining were diagnosed using PSMA-PET, with most of the patients treated to a single lymph-nodal metastasis (48/69 cases), two in 14 cases, and three in the remaining cases. The median PSA prior to SBRT was 1.35 ng/mL (range, 0.3–23.7 ng/mL). Patients received SBRT with a median total dose of 35 Gy (range, 30–40 Gy) in a median number of 5 (range, 3–6) fractions. With a median follow-up of 16 months (range, 7–59 months), our LC rates were 95.8% and 86.3% at 1 and 2 years. DPFS rates were 90.4% and 53.4%, respectively, at 1 and 2 years, with nine patients developing a sequential oligometastatic disease treated with a second course of SBRT. Polymetastatic disease-free survival (PMFS) at 1 and 2 years was 98% and 96%. Six patients needed ADT after SBRT for a median time of ADT-free survival of 15 months (range, 6–22 months). The median OS was 16 months (range, 7–59) with 1- and 2-year rates of both 98%. In multivariate analysis, higher LC rates and the use of PSMA-PET were related to improved DPFS rates, and OS was significantly related to a lower incidence of distant progression. No G3 or higher adverse events were reported. Conclusions: In our experience, lymph-nodal SBRT for oligometastatic prostate cancer is a safe and effective option for ADT delay with no severe toxicity.
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spelling pubmed-104567042023-08-26 Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience Cuccia, Francesco Tamburo, Maria Piras, Antonio Mortellaro, Gianluca Iudica, Arianna Daidone, Antonino Federico, Manuela Zagardo, Valentina Ferini, Gianluca Marletta, Francesco Spatola, Corrado Fazio, Ivan Filosto, Sergio Pergolizzi, Stefano Ferrera, Giuseppe Medicina (Kaunas) Article Background: The favorable role of SBRT for lymph-nodal oligometastases from prostate cancer has been reported by several retrospective and prospective experiences, suggesting a more indolent natural history of disease when compared to patients with bone oligometastases. This retrospective multicenter study evaluates the outcomes of a cohort of patients treated with stereotactic body radiotherapy for lymph-nodal oligometastases. Methods: Inclusion criteria were up to five lymph-nodal oligometastases detected either with Choline-PET or PSMA-PET in patients naïve for ADT or already ongoing with systemic therapy and at least 6 Gy per fraction for SBRT. Only patients with exclusive lymph-nodal disease were included. The primary endpoint of the study was LC; a toxicity assessment was retrospectively performed following CTCAE v4.0. Results: A total of 100 lymph-nodal oligometastases in 69 patients have been treated with SBRT between April 2015 and November 2022. The median age was 73 years (range, 60–85). Oligometastatic disease was mainly detected with Choline-PET in 47 cases, while the remaining were diagnosed using PSMA-PET, with most of the patients treated to a single lymph-nodal metastasis (48/69 cases), two in 14 cases, and three in the remaining cases. The median PSA prior to SBRT was 1.35 ng/mL (range, 0.3–23.7 ng/mL). Patients received SBRT with a median total dose of 35 Gy (range, 30–40 Gy) in a median number of 5 (range, 3–6) fractions. With a median follow-up of 16 months (range, 7–59 months), our LC rates were 95.8% and 86.3% at 1 and 2 years. DPFS rates were 90.4% and 53.4%, respectively, at 1 and 2 years, with nine patients developing a sequential oligometastatic disease treated with a second course of SBRT. Polymetastatic disease-free survival (PMFS) at 1 and 2 years was 98% and 96%. Six patients needed ADT after SBRT for a median time of ADT-free survival of 15 months (range, 6–22 months). The median OS was 16 months (range, 7–59) with 1- and 2-year rates of both 98%. In multivariate analysis, higher LC rates and the use of PSMA-PET were related to improved DPFS rates, and OS was significantly related to a lower incidence of distant progression. No G3 or higher adverse events were reported. Conclusions: In our experience, lymph-nodal SBRT for oligometastatic prostate cancer is a safe and effective option for ADT delay with no severe toxicity. MDPI 2023-08-09 /pmc/articles/PMC10456704/ /pubmed/37629732 http://dx.doi.org/10.3390/medicina59081442 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Cuccia, Francesco
Tamburo, Maria
Piras, Antonio
Mortellaro, Gianluca
Iudica, Arianna
Daidone, Antonino
Federico, Manuela
Zagardo, Valentina
Ferini, Gianluca
Marletta, Francesco
Spatola, Corrado
Fazio, Ivan
Filosto, Sergio
Pergolizzi, Stefano
Ferrera, Giuseppe
Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience
title Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience
title_full Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience
title_fullStr Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience
title_full_unstemmed Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience
title_short Stereotactic Body Radiotherapy for Lymph-Nodal Oligometastatic Prostate Cancer: A Multicenter Retrospective Experience
title_sort stereotactic body radiotherapy for lymph-nodal oligometastatic prostate cancer: a multicenter retrospective experience
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456704/
https://www.ncbi.nlm.nih.gov/pubmed/37629732
http://dx.doi.org/10.3390/medicina59081442
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