Clinical Outcomes of Stereotactic Body Radiotherapy With Immediate Versus Delayed Hormone Therapy in Men With Oligometastatic Recurrence of Prostate Cancer.
Autor: | Chaw CL; Academic Unit of Radiotherapy and Oncology, Royal Marsden NHS Foundation Trust, Chelsea, London, UK. Electronic address: 0109061c@doctors.org.uk., deSouza NM; Cancer Research UK Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, Sutton, UK., Khoo V; Academic Unit of Radiotherapy and Oncology, Royal Marsden NHS Foundation Trust, Chelsea, London, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, Sutton, London, UK., Suh YE; Academic Unit of Radiotherapy and Oncology, Royal Marsden NHS Foundation Trust, Chelsea, London, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, Sutton, London, UK., van As N; Academic Unit of Radiotherapy and Oncology, Royal Marsden NHS Foundation Trust, Chelsea, London, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, Sutton, London, UK. |
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Jazyk: | angličtina |
Zdroj: | Clinical oncology (Royal College of Radiologists (Great Britain)) [Clin Oncol (R Coll Radiol)] 2020 Aug; Vol. 32 (8), pp. 509-517. Date of Electronic Publication: 2020 May 16. |
DOI: | 10.1016/j.clon.2020.03.008 |
Abstrakt: | Aims: Stereotactic body radiotherapy (SBRT) with the delayed option of androgen deprivation therapy (ADT) is the current treatment paradigm in men relapsed with oligometastatic prostate cancer based on the outcome of a phase II randomised controlled study. The immediate (concomitant) use of ADT in this clinical setting potentially augments the efficacy of SBRT by improving systemic disease control. The aim of this study was to compare the clinical outcomes of these two treatment strategies. Materials and Methods: Eighty-eight patients with up to three oligometastases and controlled primary disease who had been treated using SBRT with immediate or delayed ADT were included in this retrospective analysis. Progression-free survival (PFS), widespread failure-free survival (WFFS) and freedom from further interventions (FFFI) were assessed using Kaplan-Meier and Cox proportional hazard regression methods. Toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Results: Thirty-nine patients (44.3%) were treated with SBRT and immediate ADT (continuous ADT, n = 7; intermittent ADT, n = 32) and 49 (55.7%) with SBRT and delayed ADT. The median follow-up was 24 months (interquartile range 13.5-37.0 months). PFS in the immediate and delayed ADT groups were 26 months and 16 months, respectively (P < 0.007). The median WFFS in the immediate ADT group was not reached compared with 21 months in the delayed ADT group (P = 0.025). The 1- and 2-year FFFI in the immediate ADT group were 88% and 64.1%, respectively, significantly higher than those in the delayed ADT group (63.8% and 30.2%, respectively, P < 0.002). Acute toxicities of grade 1-2 occurred in 17.9% of the immediate ADT group and 18.4% of the delayed ADT group (P = 0.96). Only one case of grade 3 late toxicity (pelvic insufficiency) was identified in this study. Conclusions: SBRT with concomitant ADT improves PFS, WFFS and FFFI as compared with SBRT with delayed ADT; this finding needs validation in a prospective, randomised study. (Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.) |
Databáze: | MEDLINE |
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