Antonino Battaglia1, Gaëtan Devos1, Karel Decaestecker2, Manuel Witters1, Lisa Moris1, Thomas Van den Broeck1, Charlien Berghen3, Wouter Everaerts1, Maarten Albersen1, Arman Tsaturyan4, Gert De Meerleer3, Hein Van Poppel1, Karolien Goffin5, Piet Ost6, Lorenzo Tosco1,5,7, Steven Joniau8. 1. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. 2. Department of Urology, University Hospital Ghent, Ghent, Belgium. 3. Department of Radiation Oncology, University Hospitals Leuven, Louvain, Belgium. 4. Department of Urology, Astghik Medical Center, Yerevan, Armenia. 5. Nuclear Medicine and Molecular Imaging, KU Leuven, Louvain, Belgium. 6. Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium. 7. Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy. 8. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium. steven.joniau@uzleuven.be.
Abstract
OBJECTIVES: Metastasis direct therapy (MDT) is a common practice in different fields of oncology. However, there is a lack of data on surgical MDT in visceral/skeletal oligometastatic prostate cancer (PCa). We aimed to assess the role of surgical excision of visceral and skeletal PCa recurrence. METHODS: Seventeen PCa patients experienced metachronous visceral or skeletal oligometastatic recurrence following maximal local treatment. Oligometastatic recurrence was defined as 1-3 lesions, detected with the best imaging technique available at the time of diagnosis. All patients underwent metastasectomy and were followed for a median of 43 months. Postoperative complications were graded using the Clavien-Dindo classification of surgical complications. Kaplan-Meier plots were used to assess overall survival. RESULTS: Fourteen patients (82%) had visceral lesions, two had bone lesions (12%), and one had an abdominal wall metastasis (6%). Four patients (24%) were under active ADT at the time of metastasectomy. PSA decreased after metastasectomy in 16 (94%) patients. Ten (77%) of the 13 ADT-naïve patients had a PSA decrease of ≥ 50%. Following metastasectomy, 16 (94.1%) patients developed metastatic recurrence of which 11 (64.7%) were again oligometastatic, amenable for repeated MDT. The median time to metastatic recurrence was 14 months (range 6.4-40). We observed 8% Clavien-Dindo grade 3-4 complications in 21 procedures. CONCLUSIONS: In this report, we analyzed the outcomes of surgical excision of visceral and skeletal PCa recurrence following primary treatment. We found that removing metastasis to the bone and viscera can be associated with long-term disease-free periods at a low rate of serious complications. These exploratory results should be confirmed in prospective studies.
OBJECTIVES: Metastasis direct therapy (MDT) is a common practice in different fields of oncology. However, there is a lack of data on surgical MDT in visceral/skeletal oligometastatic prostate cancer (PCa). We aimed to assess the role of surgical excision of visceral and skeletal PCa recurrence. METHODS: Seventeen PCa patients experienced metachronous visceral or skeletal oligometastatic recurrence following maximal local treatment. Oligometastatic recurrence was defined as 1-3 lesions, detected with the best imaging technique available at the time of diagnosis. All patients underwent metastasectomy and were followed for a median of 43 months. Postoperative complications were graded using the Clavien-Dindo classification of surgical complications. Kaplan-Meier plots were used to assess overall survival. RESULTS: Fourteen patients (82%) had visceral lesions, two had bone lesions (12%), and one had an abdominal wall metastasis (6%). Four patients (24%) were under active ADT at the time of metastasectomy. PSA decreased after metastasectomy in 16 (94%) patients. Ten (77%) of the 13 ADT-naïve patients had a PSA decrease of ≥ 50%. Following metastasectomy, 16 (94.1%) patients developed metastatic recurrence of which 11 (64.7%) were again oligometastatic, amenable for repeated MDT. The median time to metastatic recurrence was 14 months (range 6.4-40). We observed 8% Clavien-Dindo grade 3-4 complications in 21 procedures. CONCLUSIONS: In this report, we analyzed the outcomes of surgical excision of visceral and skeletal PCa recurrence following primary treatment. We found that removing metastasis to the bone and viscera can be associated with long-term disease-free periods at a low rate of serious complications. These exploratory results should be confirmed in prospective studies.
Entities:
Keywords:
Metastasectomy; Oligometastatic; Prostate cancer; Radiotherapy; SBRT; Surgery
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: Arun Z Thomas; Mehrad Adibi; Leonardo D Borregales; Christopher G Wood; Jose A Karam Journal: Curr Opin Urol Date: 2015-09 Impact factor: 2.309
Authors: Philip Cornford; Joaquim Bellmunt; Michel Bolla; Erik Briers; Maria De Santis; Tobias Gross; Ann M Henry; Steven Joniau; Thomas B Lam; Malcolm D Mason; Henk G van der Poel; Theo H van der Kwast; Olivier Rouvière; Thomas Wiegel; Nicolas Mottet Journal: Eur Urol Date: 2016-08-31 Impact factor: 20.096
Authors: Ofer Yossepowitch; Fernando J Bianco; Scott E Eggener; James A Eastham; Howard I Scher; Peter T Scardino Journal: Eur Urol Date: 2006-10-30 Impact factor: 20.096
Authors: Christopher J Kane; Christopher L Amling; Peter A S Johnstone; Nali Pak; Raymond S Lance; J Brantley Thrasher; John P Foley; Robert H Riffenburgh; Judd W Moul Journal: Urology Date: 2003-03 Impact factor: 2.649
Authors: Karel Decaestecker; Gert De Meerleer; Bieke Lambert; Louke Delrue; Valérie Fonteyne; Tom Claeys; Filip De Vos; Wouter Huysse; Arne Hautekiet; Gaethan Maes; Piet Ost Journal: Radiat Oncol Date: 2014-06-12 Impact factor: 3.481
Authors: Gregor Habl; Christoph Straube; Kilian Schiller; Marciana Nona Duma; Markus Oechsner; Kerstin A Kessel; Matthias Eiber; Markus Schwaiger; Hubert Kübler; Jürgen E Gschwend; Stephanie E Combs Journal: BMC Cancer Date: 2017-05-22 Impact factor: 4.430
Authors: Kamran A Ahmed; Brandon M Barney; Brian J Davis; Sean S Park; Eugene D Kwon; Kenneth R Olivier Journal: Front Oncol Date: 2013-01-22 Impact factor: 6.244