Androgen deprivation and high-dose radiotherapy for oligometastatic prostate cancer patients with less than five regional and/or distant metastases

Autor: Thomas Zilli, Michel Rouzaud, Osman Ratib, Ulrike Schick, Philippe Nouet, Sandra Jorcano, Raymond Miralbell, Hansjoerg Vees, Damien C. Weber
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Urology
ddc:616.0757
Prostate cancer
medicine
Humans
Radiology
Nuclear Medicine and imaging
Radiopharmaceuticals/diagnostic use
External beam radiotherapy
Neoplasm Metastasis
Neoplasm Recurrence
Local/mortality/pathology/therapy
Survival rate
Neoadjuvant therapy
Aged
Neoplasm Staging
Aged
80 and over
Prostatectomy
business.industry
Prostatic Neoplasms
Androgen Antagonists
Dose-Response Relationship
Radiation
Hematology
General Medicine
Chemoradiotherapy
Middle Aged
medicine.disease
Prognosis
Neoadjuvant Therapy
Radiation therapy
Survival Rate
Prostatic Neoplasms/mortality/pathology/therapy
Oncology
Concomitant
Positron-Emission Tomography
Neoplasm Recurrence
Local
Radiopharmaceuticals
Radiotherapy
Conformal
Nuclear medicine
business
Androgen Antagonists/therapeutic use
Tomography
X-Ray Computed
Follow-Up Studies
Zdroj: Acta Oncologica, Vol. 52, No 8 (2013) pp. 1622-8
ISSN: 0284-186X
Popis: Background. Substantial survival may be observed with oligometastatic prostate cancer. Combining androgen deprivation (AD) and high-dose external beam radiotherapy (RT) to isolated regional or distant lesions may be proposed for these patients and the outcome of this strategy is the purpose of the present report. Material and methods. From 2003 to 2010, 50 prostate cancer patients were diagnosed with synchronous (n � 7) or metachronous (n � 43) oligometastases (OM). Among the relapsing patients, the recurrence occurred after radical prostatectomy in 33 patients and curative RT ( � AD) in 10 patients. The median age at diagnosis was 63 years (range, 48 – 82). All patients underwent a bone scan and 18Fcholine or 11C-acetate PET-CT at the time of diagnosis or relapse, showing regional and/or distant nodal and bone and/ or visceral metastases in 33 and 17 patients, respectively. The median delivered effective dose was 64 Gy. All but one patient received neo-adjuvant and concomitant AD. Results. After a median follow-up of 31 months (range, 9 – 89) the three-year biochemical relapse-free survival (bRFS), clinical failure-free survival, and overall survival rates were 54.5%, 58.6% and 92%, respectively. No grade 3 toxicity was observed. Improved bRFS was found to be signifi cantly associated with the number of OM. The three-year bRFS was 66.5% versus 36.4% for patients with 1 and � 1 OMs (p � 0.031). A normalised total dose (NTD in 2 Gy/fraction, alpha/beta � 2 Gy) above 64 Gy was also correlated with a better three-year bRFS compared to lower doses: 65% vs. 41.8%, respectively (p � 0.005). On multivariate analysis, only the NTD � 64 Gy retained statistical signifi cance (HR: 0.37, 95% CI 0.15 – 0.93). Conclusion. Oligometastatic patients may be successfully treated with short AD and high-dose irradiation to the metastatic lesions. High dose improves bRFS. Such a treatment strategy may hypothetically succeed to prolong the failure-free interval between two consecutive AD courses.
Databáze: OpenAIRE
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