Jonathan L Muldermans1, Lindsay B Romak2, Eugene D Kwon3, Sean S Park2, Kenneth R Olivier4. 1. F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. 2. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. 3. Department of Urology, Mayo Clinic, Rochester, Minnesota; Department of Immunology, Mayo Clinic, Rochester, Minnesota. 4. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. Electronic address: olivier.kenneth@mayo.edu.
Abstract
PURPOSE: To review outcomes of patients with oligometastatic prostate cancer (PCa) treated with stereotactic body radiation therapy (SBRT) and to identify variables associated with local failure. METHODS AND MATERIALS: We retrospectively reviewed records of patients treated with SBRT for oligometastatic PCa. Metastasis control (ie, control of the treated lesion, MC), biochemical progression-free survival, distant progression-free survival, and overall survival were estimated with the Kaplan-Meier method. RESULTS: Sixty-six men with 81 metastatic PCa lesions, 50 of which were castrate-resistant, were included in the analysis. Lesions were in bone (n=74), lymph nodes (n=6), or liver (n=1). Stereotactic body radiation therapy was delivered in 1 fraction to 71 lesions (88%), at a median dose of 16 Gy (range, 16-24 Gy). The remaining lesions received 30 Gy in 3 fractions (n=6) or 50 Gy in 5 fractions (n=4). Median follow-up was 16 months (range, 3-49 months). Estimated MC at 2 years was 82%. Biochemical progression-free survival, distant progression-free survival, and overall survival were 54%, 45%, and 83%, respectively. On multivariate analysis, only the dose of SBRT was significantly associated with MC; lesions treated with 16 Gy had 58% MC, and those treated with ≥18 Gy had 95% MC at 2 years (P≤.001). At 2 years, MC for lesions treated with 18 Gy (n=21) was 88%. No patient treated with ≥18 Gy in a single fraction or with any multifraction regimen had local failure. Six patients (9%) had grade 1 pain flare, and 2 (3%) had grade 2 pain flare. No grade 2 or greater late toxicities were reported. CONCLUSIONS: Stereotactic body radiation therapy for patients with oligometastatic prostate cancer provided optimal metastasis control and acceptable toxicity with doses ≥18 Gy. Biochemical progression-free survival was 54% at 16 months with the inclusion of SBRT in the treatment regimen. Stereotactic body radiation therapy should be considered in patients with castration-refractory, oligometastatic prostate cancer who have limited options for systemic therapy.
PURPOSE: To review outcomes of patients with oligometastatic prostate cancer (PCa) treated with stereotactic body radiation therapy (SBRT) and to identify variables associated with local failure. METHODS AND MATERIALS: We retrospectively reviewed records of patients treated with SBRT for oligometastatic PCa. Metastasis control (ie, control of the treated lesion, MC), biochemical progression-free survival, distant progression-free survival, and overall survival were estimated with the Kaplan-Meier method. RESULTS: Sixty-six men with 81 metastatic PCa lesions, 50 of which were castrate-resistant, were included in the analysis. Lesions were in bone (n=74), lymph nodes (n=6), or liver (n=1). Stereotactic body radiation therapy was delivered in 1 fraction to 71 lesions (88%), at a median dose of 16 Gy (range, 16-24 Gy). The remaining lesions received 30 Gy in 3 fractions (n=6) or 50 Gy in 5 fractions (n=4). Median follow-up was 16 months (range, 3-49 months). Estimated MC at 2 years was 82%. Biochemical progression-free survival, distant progression-free survival, and overall survival were 54%, 45%, and 83%, respectively. On multivariate analysis, only the dose of SBRT was significantly associated with MC; lesions treated with 16 Gy had 58% MC, and those treated with ≥18 Gy had 95% MC at 2 years (P≤.001). At 2 years, MC for lesions treated with 18 Gy (n=21) was 88%. No patient treated with ≥18 Gy in a single fraction or with any multifraction regimen had local failure. Six patients (9%) had grade 1 pain flare, and 2 (3%) had grade 2 pain flare. No grade 2 or greater late toxicities were reported. CONCLUSIONS: Stereotactic body radiation therapy for patients with oligometastatic prostate cancer provided optimal metastasis control and acceptable toxicity with doses ≥18 Gy. Biochemical progression-free survival was 54% at 16 months with the inclusion of SBRT in the treatment regimen. Stereotactic body radiation therapy should be considered in patients with castration-refractory, oligometastatic prostate cancer who have limited options for systemic therapy.
Authors: Simon S Lo; Achilles J Fakiris; Eric L Chang; Nina A Mayr; Jian Z Wang; Lech Papiez; Bin S Teh; Ronald C McGarry; Higinia R Cardenes; Robert D Timmerman Journal: Nat Rev Clin Oncol Date: 2009-12-08 Impact factor: 66.675
Authors: Howard I Scher; Karim Fizazi; Fred Saad; Mary-Ellen Taplin; Cora N Sternberg; Kurt Miller; Ronald de Wit; Peter Mulders; Kim N Chi; Neal D Shore; Andrew J Armstrong; Thomas W Flaig; Aude Fléchon; Paul Mainwaring; Mark Fleming; John D Hainsworth; Mohammad Hirmand; Bryan Selby; Lynn Seely; Johann S de Bono Journal: N Engl J Med Date: 2012-08-15 Impact factor: 91.245
Authors: Joseph K Salama; Michael D Hasselle; Steven J Chmura; Renuka Malik; Neil Mehta; Kamil M Yenice; Victoria M Villaflor; Walter M Stadler; Philip C Hoffman; Ezra E W Cohen; Philip P Connell; Daniel J Haraf; Everett E Vokes; Samuel Hellman; Ralph R Weichselbaum Journal: Cancer Date: 2011-10-21 Impact factor: 6.860
Authors: Howard I Scher; Susan Halabi; Ian Tannock; Michael Morris; Cora N Sternberg; Michael A Carducci; Mario A Eisenberger; Celestia Higano; Glenn J Bubley; Robert Dreicer; Daniel Petrylak; Philip Kantoff; Ethan Basch; William Kevin Kelly; William D Figg; Eric J Small; Tomasz M Beer; George Wilding; Alison Martin; Maha Hussain Journal: J Clin Oncol Date: 2008-03-01 Impact factor: 44.544
Authors: C Leigh Moyer; Ryan Phillips; Matthew P Deek; Noura Radwan; Ashley E Ross; Emmanuel S Antonarakis; Diane Reyes; Jean Wright; Stephanie A Terezakis; Daniel Y Song; Curtiland DeVille; Patrick C Walsh; Theodore L DeWeese; Michael Carducci; Edward M Schaeffer; Kenneth J Pienta; Mario Eisenberger; Phuoc T Tran Journal: World J Urol Date: 2018-09-06 Impact factor: 4.226
Authors: Jeremie Calais; Johannes Czernin; Minsong Cao; Amar U Kishan; John V Hegde; Narek Shaverdian; Kiri Sandler; Fang-I Chu; Chris R King; Michael L Steinberg; Isabel Rauscher; Nina-Sophie Schmidt-Hegemann; Thorsten Poeppel; Philipp Hetkamp; Francesco Ceci; Ken Herrmann; Wolfgang P Fendler; Matthias Eiber; Nicholas G Nickols Journal: J Nucl Med Date: 2017-11-09 Impact factor: 10.057
Authors: Christian Daniel Fankhauser; Cédric Poyet; Stephanie G C Kroeze; Benedikt Kranzbühler; Helena I Garcia Schüler; Matthias Guckenberger; Philipp A Kaufmann; Thomas Hermanns; Irene A Burger Journal: World J Urol Date: 2018-07-20 Impact factor: 4.226
Authors: Chris W D Armstrong; Jonathan A Coulter; Chee Wee Ong; Pamela J Maxwell; Steven Walker; Karl T Butterworth; Oksana Lyubomska; Silvia Berlingeri; Rebecca Gallagher; Joe M O'Sullivan; Suneil Jain; Ian G Mills; Kevin M Prise; Robert G Bristow; Melissa J LaBonte; David J J Waugh Journal: NAR Cancer Date: 2020-07-03
Authors: Jaden D Evans; Lindsay K Morris; Henan Zhang; Siyu Cao; Xin Liu; Kristin C Mara; Bradley J Stish; Brian J Davis; Aaron S Mansfield; Roxana S Dronca; Matthew J Iott; Eugene D Kwon; Robert L Foote; Kenneth R Olivier; Haidong Dong; Sean S Park Journal: Int J Radiat Oncol Biol Phys Date: 2018-09-08 Impact factor: 7.038
Authors: Paul Rogowski; Christian Trapp; Rieke von Bestenbostel; Nina-Sophie Schmidt-Hegemann; Run Shi; Harun Ilhan; Alexander Kretschmer; Christian Stief; Ute Ganswindt; Claus Belka; Minglun Li Journal: Radiat Oncol Date: 2021-06-30 Impact factor: 3.481