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Review
. 2021 Jan 18:10:606260.
doi: 10.3389/fonc.2020.606260. eCollection 2020.

Rationale for Involved Field Stereotactic Body Radiation Therapy-Enhanced Intermittent Androgen Deprivation Therapy in Hormone-Sensitive Nodal Oligo-Recurrent Prostate Cancer Following Prostate Stereotactic Body Radiation Therapy

Michael Carrasquilla  1 , Michael L Creswell  2 , Abigail N Pepin  3 , Edina Wang  1 , Matthew Forsthoefel  1 , Mary McGunigal  1 , Elizabeth Bullock  1 , Siyuan Lei  1 , Brian T Collins  1 , Jonathan W Lischalk  1 , Giuseppe Esposito  4 , Nima Aghdam  5 , Deepak Kumar  6 , Simeng Suy  1 , Paul Leger  7 , Ryan A Hankins  8 , Nancy A Dawson  7 , Sean P Collins  1
Affiliations
Review

Rationale for Involved Field Stereotactic Body Radiation Therapy-Enhanced Intermittent Androgen Deprivation Therapy in Hormone-Sensitive Nodal Oligo-Recurrent Prostate Cancer Following Prostate Stereotactic Body Radiation Therapy

Michael Carrasquilla et al. Front Oncol. .

Abstract

Lymph node recurrent prostate cancer is a common clinical scenario that is likely to increase significantly with the widespread adoption of novel positron emission tomography (PET) agents. Despite increasing evidence that localized therapy is disease modifying, most men with lymph node recurrent prostate cancer receive only systemic therapy with androgen deprivation therapy (ADT). For men who receive localized therapy the intent is often to delay receipt of systemic therapy. Little evidence exists on the optimal combination of local and systemic therapy in this patient population. In this hypothesis generating review, we will outline the rationale and propose a framework for combining involved field SBRT with risk adapted intermittent ADT for hormone sensitive nodal recurrent prostate cancer. In patients with a limited number of nodal metastases, involved field stereotactic body radiation therapy (SBRT) may have a role in eliminating castrate-resistant clones and possibly prolonging the response to intermittent ADT. We hypothesize that in a small percentage of patients, such a treatment approach may lead to long term remission or cure.

Keywords: Nodal Oligo-recurrence; hormone sensitive; intermittent ADT; involved field SBRT; prostate SBRT; prostate cancer.

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Conflict of interest statement

SP Collins and BT Collins serve as clinical consultants to Accuray Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Nodal radiation therapy treatment volumes.
Figure 2
Figure 2
An 80-year-old gentleman with oligo-recurrent prostate cancer with left external iliac adenopathy identified on PET imaging [(A) Axial, (B) Sagittal, (C) Coronal views]. The decision was to proceed with SBRT assisted Intermittent ADT. An involved field SBRT approach was utilized. The left external iliac, left obturator, and left internal iliac nodal regions were treated with 27.5 Gy in 5 fractions (high risk CTV), with a 30 Gy simultaneous integrated boost to the gross disease. Treatment planning computed tomography images showing the isodose lines for the GTV prescription of 30 Gy (red) and the High-risk CTV prescription of 27.5 Gy (dark blue line). Following SBRT, induction ADT was initiated.
Figure 3
Figure 3
Proposed treatment volumes for Involved Field SBRT.
Figure 4
Figure 4
Involved Field SBRT assisted I-ADT Treatment Cycle.
See this image and copyright information in PMC

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