Stereotactic body radiotherapy for oligoprogressive lesions in metastatic castration‐resistant prostate cancer patients during abiraterone/enzalutamide treatment

Autor: Sadık Muallaoğlu, Cem Onal, Pervin Hurmuz, Fadil Akyol, Ezgi Oymak, Sercan Aksoy, Burak Tilki, Fatih Kose, Gokhan Ozyigit, Ozan Cem Guler
Rok vydání: 2021
Předmět:
Male
0301 basic medicine
Oncology
Cancer Research
medicine.medical_specialty
Multivariate analysis
Urology
medicine.medical_treatment
Antineoplastic Agents
Radiosurgery
Metastasis
03 medical and health sciences
chemistry.chemical_compound
Prostate cancer
0302 clinical medicine
Prostate
Internal medicine
Nitriles
Phenylthiohydantoin
medicine
Humans
Enzalutamide
Radiology
Nuclear Medicine and imaging
Neoplasm Metastasis
Neoplasm Staging
Univariate analysis
Chemotherapy
Radiation
business.industry
Middle Aged
Prostate-Specific Antigen
Prognosis
medicine.disease
Combined Modality Therapy
Progression-Free Survival
Prostatic Neoplasms
Castration-Resistant
Abiraterone
Treatment Outcome
030104 developmental biology
medicine.anatomical_structure
chemistry
030220 oncology & carcinogenesis
Benzamides
Androstenes
business
Stereotactic body radiotherapy
Zdroj: The Prostate. 81:543-552
ISSN: 1097-0045
0270-4137
DOI: 10.1002/pros.24132
Popis: Purpose/objective(s) Metastasis- directed therapy (MDT) utilizing stereotactic body radiotherapy (SBRT) for oligoprogressive lesions could provide a delay in next-line systemic treatment (NEST) change while undergoing androgen receptor-targeted agents (ARTA) treatment. We evaluated prognostic factors for prostate cancer-specific survival (PCSS) and progression-free survival (PFS) to characterize patients receiving treatment with ARTA who may benefit from MDT for oligoprogressive lesions. The impact of MDT on delaying NEST and the predictive factors for NEST-free survival (NEST-FS) were also assessed. Materials/methods The clinical data of 54 metastatic castration-resistant prostate cancer patients with 126 oligoprogressive lesions receiving abiraterone (1 g/day) or enzalutamide (160 mg/day) before or after systemic chemotherapy were analyzed. A median of three lesions (range: 1-5) were treated with MDT. The primary end points were PCSS and PFS. The secondary end points were time to switch to NEST and NEST-FS. Results The median follow-up time was 19.1 months. Univariate analysis showed that the number of oligoprogressive lesions treated with SBRT and the time between the start of ARTA treatment and oligoprogression were significant prognostic factors for PCSS, and the timing of ARTA treatment (before or after chemotherapy) and the PSA response after MDT were significant prognostic factors for PFS. Multivariate analysis showed that early MDT for oligoprogressive lesions delivered less than six months after beginning of ARTA [HR = 3.20 (95% CI, 1.12-9.15); P = 0.03] and higher PSA levels after MDT [HR = 1.01 (95% CI 1.00-1.01), P = 0.02] were significant predictors of worse PCSS and PFS. The median total duration of ARTA treatment was 13.8 months. The median time between the start of ARTA treatment and the start of MDT for oligoprogressive lesions was 5.2 months, and MDT extended the ARTA treatment by 8.6 months on average. Thirty-two (59.3%) patients continued ARTA treatment after MDT. ARTA treatment after chemotherapy, early oligoprogression requiring MDT, and lower radiation doses for MDT were independent predictors of NEST-FS in multivariate analysis. Conclusion MDT for oligoprogressive lesions is effective and may provide several benefits compared to switching from ARTA treatment to NEST. Patients with early progression while on ARTAs and inadequate PSA responses after MDT have a greater risk of rapid disease progression and poor survival, which necessitates intensified treatment.
Databáze: OpenAIRE
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