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. 2019 Sep 9;19(1):84.
doi: 10.1186/s12894-019-0515-z.

Predictive factors for response to salvage stereotactic body radiotherapy in oligorecurrent prostate cancer limited to lymph nodes: a single institution experience

Christoph Oehler  1 , Michel Zimmermann  2 , Lukas Adam  2 , Juergen Curschmann  3 , Marcin Sumila  3 , Räto T Strebel  4 , Richard Cathomas  5 , Qiyu Li  6 , Uwe Schneider  3 , Daniel R Zwahlen  2
Affiliations

Predictive factors for response to salvage stereotactic body radiotherapy in oligorecurrent prostate cancer limited to lymph nodes: a single institution experience

Christoph Oehler et al. BMC Urol. .

Abstract

Background: In patients presenting with limited nodal recurrence following radical prostatectomy (RP), stereotactic body radiotherapy (SBRT) results might improve with a better case selection.

Methods: Single-institution retrospective analysis of patients presenting with 1-3 lymph node (LN) recurrences (N1 or M1a) on 18F-Choline PET/CT. Prior therapy included radical prostatectomy (RP) ± salvage radiotherapy (RT), in absence of any systemic therapy. Outcome parameters were biochemical response (BR), time to biochemical recurrence (TBR) and time interval between SBRT and androgen deprivation therapy start (TADT). Time to event endpoints was analysed using Kaplan-Meier method. Potential prognostic factors were examined using univariate proportional hazards regression for TADT and logistic regression for BR. The optimal cut-off point for LN size was calculated using the Contal and O'Quigley method.

Results: 25 patients fulfilling study criteria were treated with SBRT from January 2010 to January 2015 and retrospectively analysed. Median follow up was 18 months and median LN diameter 10.5 mm. SBRT was delivered to a median dose of 36 Gy in three fractions (range: 30-45 Gy). BR was reached in 52% of cases. Median TBR was 11.9 months and significantly longer in patients with larger LN (Hazard ratio [HR] = 0.87, P = 0.03). Using 14 mm as cut off for LN, median TBR was 10.8 months for patients with small LN (18 patients), and 21.2 months for patients with large LN (6 patients) (P unadjusted = 0.009; P adjusted = 0.099). ADT was started in 32% of patients after a median follow-up of 18 months.

Conclusions: For PCa patients with 1-3 LN recurrence after RP (± salvage RT), SBRT might result in a better biochemical control when delivered to larger sized (≥ 14 mm) LN metastases. This study is hypothesis generating and results should be tested in a larger prospective trial.

Keywords: Body radiotherapy; Lymph node metastases; Prostate cancer; Recurrence; Salvage therapy; Stereotactic.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Best biochemical response after SBRT
Fig. 2
Fig. 2
Time to biochemical recurrence after SBRT according to LN size (≤ 14 mm vs. > 14 mm)
Fig. 3
Fig. 3
Time to biochemical recurrence after SBRT according to LN number (1 vs. 2–3)
See this image and copyright information in PMC

References

    1. Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, et al. Surveillance or metastasis-directed therapy for Oligometastatic prostate Cancer recurrence: a prospective, randomized, multicenter phase II trial. J Clin Oncol. 2018;36:446–453. doi: 10.1200/JCO.2017.75.4853. - DOI - PubMed
    1. Siva S, Bressel M, Murphy DG, Shaw M, Chander S, Violet J, et al. Stereotactic Ablative Body Radiotherapy (SABR) for Oligometastatic Prostate Cancer: A Prospective Clinical Trial. Eur Urol. 2018;74(4):455–462. doi: 10.1016/j.eururo.2018.06.004. - DOI - PubMed
    1. Radwan N, Phillips R, Ross A, Rowe SP, Gorin MA, Antonarakis ES, et al. A phase II randomized trial of Observation versus stereotactic ablative RadiatIon for OLigometastatic prostate CancEr (ORIOLE) BMC Cancer. 2017;17(1):453. doi: 10.1186/s12885-017-3455-6. - DOI - PMC - PubMed
    1. Ost P, Bossi A, Decaestecker K, De Meerleer G, Giannarini G, Karnes RJ, et al. Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol. 2015;67:852–863. doi: 10.1016/j.eururo.2014.09.004. - DOI - PubMed
    1. Amling CL, Bergstralh EJ, Blute ML, Slezak JM, Zincke H. Defining prostate specific antigen progression after radical prostatectomy: what is the most appropriate cut point? J Urol. 2001;165:1146–1151. doi: 10.1016/S0022-5347(05)66452-X. - DOI - PubMed