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. 2017 Oct;15(5):e773-e782.
doi: 10.1016/j.clgc.2017.03.009. Epub 2017 Mar 29.

Benefits of Using Stereotactic Body Radiotherapy in Patients With Metachronous Oligometastases of Hormone-Sensitive Prostate Cancer Detected by [18F]fluoromethylcholine PET/CT

Esther W Bouman-Wammes  1 , Joyce M van Dodewaard-De Jong  2 , Max Dahele  3 , Matthijs C F Cysouw  4 , Otto S Hoekstra  4 , R Jeroen A van Moorselaar  5 , Maartje A H Piet  3 , Hein J Verberne  6 , Adriaan D Bins  7 , Henk M W Verheul  8 , Ben J Slotman  3 , Daniela E Oprea-Lager  4 , Alfons J M Van den Eertwegh  8
Affiliations

Benefits of Using Stereotactic Body Radiotherapy in Patients With Metachronous Oligometastases of Hormone-Sensitive Prostate Cancer Detected by [18F]fluoromethylcholine PET/CT

Esther W Bouman-Wammes et al. Clin Genitourin Cancer. 2017 Oct.

Abstract

Introduction: For patients with oligometastatic recurrence of prostate cancer (PC), stereotactic body radiation therapy (SBRT) represents an attractive treatment option, as it is safe without major side effects. The aim of this study was to investigate the impact of SBRT in delaying the start of androgen deprivation therapy (ADT).

Patients and methods: Forty-three patients treated with SBRT for oligometastatic recurrence (< 5 metastases) of hormone-sensitive PC, defined with [18F]fluoromethylcholine positron emission tomography/computed tomography were included. As a control group, 20 patients with oligometastatic disease not treated with SBRT were identified from another hospital. Data were collected retrospectively.

Results: A post-SBRT prostate-specific antigen (PSA) response was seen in 29 (67.4%) of 43 patients. Median ADT-free survival (ADT-FS) was 15.6 months (95% confidence interval [CI], 11.7-19.5) for the whole group, and 25.7 months (95% CI, 9.0-42.4) for patients with a PSA response. Seven patients were treated with a second course of SBRT because of oligometastatic disease recurrence; the ADT-FS in this group was 32.1 months (95% CI, 7.8-56.5). Compared with the control group, the ADT-FS from first diagnosis of metastasis was significantly longer, with 17.3 (95% CI, 13.7-20.9) months versus 4.19 months (95% CI, 0.0-9.0), P < .001. Also, time between diagnosis of the metastasis until progression of disease during ADT use (castration resistance) was longer for the SBRT-treated patients (mean 66.6, 95% CI, 53.5-79.8, vs. 36.41, 95% CI, 26.0-46.8 months, P = .020). There were no grade III or IV adverse events reported.

Conclusion: SBRT can safely and effectively be used to postpone ADT in appropriately selected patients with oligometastatic recurrence of PC.

Keywords: ADT-free survival; Androgen deprivation therapy; Oligometastatic recurrence of prostate cancer; PSA response; SBRT.

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