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. 2013 Jan 22:2:215.
doi: 10.3389/fonc.2012.00215. eCollection 2012.

Stereotactic body radiation therapy in the treatment of oligometastatic prostate cancer

Kamran A Ahmed  1 , Brandon M Barney, Brian J Davis, Sean S Park, Eugene D Kwon, Kenneth R Olivier
Affiliations

Stereotactic body radiation therapy in the treatment of oligometastatic prostate cancer

Kamran A Ahmed et al. Front Oncol. .

Abstract

Purpose/objective(s): To report outcomes and toxicity for patients with oligometastatic (≤5 lesions) prostate cancer (PCa) treated with stereotactic body radiation therapy (SBRT).

Materials/methods: Seventeen men with 21 PCa lesions were treated with SBRT between February 2009 and November 2011. All patients had a detectable prostate-specific antigen (PSA) at the time of SBRT, and 11 patients (65%) had hormone-refractory (HR) disease. Treatment sites included bone (n = 19), lymph nodes (n = 1), and liver (n = 1). For patients with bone lesions, the median dose was 20 Gy (range, 8-24 Gy) in a single fraction (range, 1-3). All but two patients received some form of anti-androgen therapy after completing SBRT.

Results: Local control (LC) was 100%, and the PSA nadir was undetectable in nine patients (53%). The first post-SBRT PSA was lower than pre-treatment levels in 15 patients (88%), and continued to decline or remain undetectable in 12 patients (71%) at a median follow-up of 6 months (range, 2-24 months). Median PSA measurements before SBRT and at last follow-up were 2.1 ng/dl (range, 0.13-36.4) and 0.17 ng/dl (range, <0.1-140), respectively. Six (55%) of the 11 patients with HR PCa achieved either undetectable or declining PSA at a median follow-up of 4.8 months (range, 2.2-6.0 months). Reported toxicities included one case each of grade 2 dyspnea and back pain, there were no cases of grade ≥3 toxicity following treatment.

Conclusion: We report excellent LC with SBRT in oligometastatic PCa. More importantly, over half the patients achieved an undetectable PSA after SBRT. Further follow-up is necessary to assess the long-term impact of SBRT on LC, toxicity, PSA response, and clinical outcomes.

Keywords: bone metastases; intensity-modulated radiation therapy; prostate metastases; prostate-specific antigen; stereotactic body radiation therapy; stereotactic radiosurgery.

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Figures

FIGURE 1
FIGURE 1
Contours and isodose curves for a patient treated to 18 Gy in a single fraction to an right anterior T3 vertebral body metastasis. GTV is shown in cyan. PTV is shown in light green. The spinal cord is shown in red. The esophagus is shown in yellow. The skin is shown in pink. The isodose curves are: red, 110% (19.8 Gy); white, 100% (18 Gy); blue, 80% (14.4 Gy); cyan, 50% (9 Gy); and green, 25% (4.5 Gy).
FIGURE 2
FIGURE 2
Actuarial prostate cancer-specific survival (CSS) in all patients using the Kaplan–Meier method.
FIGURE 3
FIGURE 3
Actuarial freedom from distant progression (FFDP) in all patients using the Kaplan–Meier method. Y-axis represents probability of distant control.
See this image and copyright information in PMC

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