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. 2022 Apr 14:12:863609.
doi: 10.3389/fonc.2022.863609. eCollection 2022.

Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

Carole Mercier  1   2 , Marc Claessens  3 , Bart De Troyer  4 , Tibaut Debacker  5 , Karen Fransis  6 , Hendrik Vandeursen  7 , Piet Ost  1   8 , Piet Dirix  1   2
Affiliations

Survival Outcomes and Pattern of Relapse After SABR for Oligometastatic Prostate Cancer

Carole Mercier et al. Front Oncol. .

Abstract

Introduction: The addition of stereotactic ablative radiotherapy (SABR) to standard of care for patients with oligometastatic prostate cancer has the potential of improving survival and delaying further metastases. The primary aim of this analysis is to report survival outcomes and pattern of recurrence of patients with hormone-sensitive (HSPC) and castrate-resistant (CRPC) oligometastatic prostate cancer treated with SABR.

Methods: This is a single-center retrospective study of patients with oligometastatic prostate cancer treated in Iridium Network between 2014 and 2018. All patients with oligometastatic (≤3 active lesions) HSPC and CRPC treated with SABR were included. Data were collected using electronic records. Patterns of first progression following SABR were reported. Kaplan-Meier methods were used to determine survival outcomes.

Results: Eighty-seven men received SABR to 115 metastases. Nineteen patients were castrate-resistant and 68 hormone-sensitive at the time of SABR. Median follow-up was 41.6 months. In 25% of patients, no decline from baseline PSA was recorded. Median bPFS was 11.7 months (95% CI 7.6 - 18.3) for HSPC as well as CRPC (95% CI 6.4 - 24.0) (p=0.27). Median DMFS was 21.8 (95% CI 16.9 - 43.2) versus 17.6 months (95% CI 6.7 - 26.2) for HSPC versus CRPC, respectively (p=0.018). Median OS was 72.6 months (95% CI 72.6 - not reached) for HSPC and not reached for CRPC (95% CI 35.4 months - not reached) (p=0.026). For the subgroup of oligorecurrent HSPC, short-term androgen-deprivation therapy was associated with improved bPFS (median 6.0 vs. 18.3 months, HR 0.31, p<0.001) and DMFS (median 15.8 vs 29.6 months, HR 0.5, p=0.06). Information on pattern of relapse was retrieved for 79 patients: 45% (36/79) of these patients were long-term disease-free (>18 months), 28% (22/79) of patients wmere oligoprogressive (≤3 new lesions) and 27% (21/79) developed a polymetastatic relapse.

Conclusion: In this cohort, oligometastatic HSPC showed potential benefit from SABR with a median DMFS of 21.8 months. Well-selected patients with oligometastatic CRPC may also benefit from SABR. For patients with metachronous and repeat oligorecurrent HSPC, combining SABR with short-term androgen-deprivation therapy was associated with improved bPFS and DMFS. Overall, 36/87 (41%) of patients were still free from clinical relapse at 18 months.

Keywords: neoplasm metastasis; neoplasm recurrence; oligometastasis; prostate cancer; prostatic neoplasms; radiosurgery; stereotactic ablative radiotherapy; stereotactic body radiotherapy.

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Conflict of interest statement

The 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
Waterfall plot for maximal changes in PSA value. CRPC, castrate-resistant prostate cancer; HSPC, hormone-sensitive prostate cancer; PSA, prostate-specific antigen.
Figure 2
Figure 2
Kaplan-Meier plots of survival outcomes (9). ADT, androgen deprivation therapy; BPFS, biochemical progression-free survival; CRPC, castrate-resistant prostate cancer; DMFS, distant metastasis-free survival; HSPC, hormone-sensitive prostate cancer; OS, overall survival; SABR, stereotactic ablative radiotherapy. Risk tables are presented under the survival curves.
See this image and copyright information in PMC

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