Clinical outcome of PSMA-guided radiotherapy for patients with oligorecurrent prostate cancer.

Stefan A Koerber Stefan A Koerber,Klaus Herfarth Klaus Herfarth,Sonja Katayama Sonja Katayama,Erik Winter Erik Winter,Katharina Sprute Katharina Sprute,Markus Hohenfellner Markus Hohenfellner,Juergen Debus Juergen Debus,Frederik L Giesel Frederik L Giesel,Dirk Jaeger Dirk Jaeger,Stefanie Zschaebitz Stefanie Zschaebitz,Peter L Choyke Peter L Choyke,Matthias F Haefner Matthias F Haefner,Uwe Haberkorn Uwe Haberkorn,Ali Afshar-Oromieh Ali Afshar-Oromieh,Ingmar Schlampp Ingmar Schlampp,Clemens Kratochwil Clemens Kratochwil,Klaus Kopka Klaus Kopka,Tim Holland-Letz Tim Holland-Letz

doi:10.1007/s00259-020-04777-z

Abstract

PurposeFirst-line treatment of patients with recurrent, metastatic prostate cancer involves hormone therapy with or without additional systemic therapies. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) allows the detection of oligometastatic disease that may be amenable to image-guided radiotherapy. The current study classifies the type and localization of metastases and the clinical outcome of PSMA-PET/CT-guided radiotherapy to selected metastases.Materials and methodsBetween 2011 and 2019, 86 patients with recurrent, oligometastatic prostate carcinoma were identified by PSMA-PET/CT and were treated with image-guided radiotherapy of their metastases. Sites of relapse were characterized, and the primary endpoint overall survival (OS), biochemical progression-free survival (bPFS), and androgen deprivation therapy (ADT)-free survival were tabulated.ResultsIn total, 37% of the metastases were bone metastases, 48% were pelvic nodal metastases, and 15% were nodal metastases outside of the pelvis. After PSMA-guided radiotherapy, a biochemical response was detected in 83% of the cohort. A statistically significant decrease in the standard uptake value (SUV) was seen in irradiated metastases. After a median follow-up of 26 months, the 3-year OS and bPFS were 84% and 55%, respectively. The median time of ADT-free survival was 13.5 months. A better clinical outcome was observed for patients receiving concomitant ADT or more than 24 fractions of radiation.ConclusionPSMA-guided radiotherapy is a promising therapeutic approach with excellent infield control for men with oligorecurrent prostate carcinoma. However, prospective, randomized trials are necessary to determine if this approach confers a survival advantage.

Highlights

In 1995, Hellman and Weichselbaum coined the phrase “oligometastases” to describe a state of cancer with a limited number of metastases in only one or a few sites [1]
We aimed to evaluate the clinical outcome after local stereotactic body radiation therapy (SBRT) for patients with oligorecurrent prostate carcinoma detected by prostate-specific membrane antigen (PSMA)-positron emission tomography (PET)/computed tomography (CT) imaging
Inclusion criteria for this study included sufficient clinical data, recurrent prostate cancer after primary therapy, and PSMA-PET/CT imaging with oligometastatic

Summary

Introduction

In 1995, Hellman and Weichselbaum coined the phrase “oligometastases” to describe a state of cancer with a limited number of metastases in only one or a few sites [1]. Ost et al reported a significantly longer androgen deprivation therapy (ADT)-free survival for a cohort of 62 patients with oligorecurrent prostate cancer undergoing metastasis-directed therapy (MDR) compared with surveillance alone. The study was planned as a prospective, multicenter phase 2 trial, the number of patients was limited and no data were available on overall survival (OS) [8]. To this end, we aimed to evaluate the clinical outcome after local SBRT for patients with oligorecurrent prostate carcinoma detected by PSMA-PET/CT imaging

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Conclusion