Abstract
BackgroundSome patients experience oligo-progression during androgen receptor targeted therapy (ARTT) treatments. This progression might not indicate a real systemic drug resistance, but a selective monoclonal resistance. With the aim to delay the start of new line treatments we treated oligo-progressive sites with radiotherapy.MethodsFrom June 2011 to Febrary 2019, 29 consecutive metastatic castration resistant prostate cancer (mCRPC) patients were submitted to radiotherapy for oligo-progression (1–3 sites) during ARTT for a total of 37 lesions treated. Thirty-one (83.8%) lesions were treated with conformal radiotherapy and 6 (16.2%) with stereotactic radiotherapy. After radiotherapy all patients continued ARTT.ResultsMedian OS (calculated from ARTT start) was 46,6 months (range 4.4–97.5 months), 2 and 3-year OS were 82.8 and 70.7%, respectively. Median PFS was 18,4 months (range 4.4–45.3 months), 2 and 3-year PFS were 38.3 and 8.5%, respectively. Median overall duration of ARTT treatment was 14.8 months (range 4.4–45.3 months) and median duration of ARTT after radiotherapy was 4.6 months (range 1–33.8 months). Patients submitted to radiotherapy > 6 months from the start of ARTT presented a better PFS (p < 0.001) and a trend toward a better OS (p = 0.101). None patient presented RT and drug related toxicities.ConclusionsRadiotherapy of oligoprogressive sites may prolong the duration of disease control under ARTT in mCRPC patients with a possible delay in the start of new line treatment. Patients progressing within 6 months from the start of ARTT did not benefit from this approach. More studies are necessary to confirm our results and to evaluate other prognostic factor in order to select patients with high benefit from this approach.
Highlights
Some patients experience oligo-progression during androgen receptor targeted therapy (ARTT) treatments
Median progression free survival (PFS) for patients treated with ARTT as first line was 14.9 months and in patients treated as second-third approach was 14.2 months (p = 0.400)
Patients submitted to radiotherapy < 6 and > 6 months after the start of ARTT presented a median PFS of 7.9 months and 27.7 months, respectively (p < 0.001) (Fig. 2)
Summary
Some patients experience oligo-progression during androgen receptor targeted therapy (ARTT) treatments. This progression might not indicate a real systemic drug resistance, but a selective monoclonal resistance. Advances in clinical and molecular imaging techniques have led to the recognition of an intermediate state of metastatic prostate cancer (mPCa) in which the disease has extended beyond the prostate, with limited spread to distant organs. This state was first identified and given the terminology, oligometastasis, in 1995 by Hellman and Weichselbaum [1]. Three categories of oligometastatic PCa have been defined: de novo oligometastases (synchronous oligometastases), recurrent (metachronous oligometastases), and progressive (induced oligometastases)
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