Abstract
Purpose/objective(s): To report outcomes and toxicity for patients with oligometastatic (≤5 lesions) prostate cancer (PCa) treated with stereotactic body radiation therapy (SBRT). Materials/methods: Seventeen men with 21 PCa lesions were treated with SBRT between February 2009 and November 2011. All patients had a detectable prostate-specific antigen (PSA) at the time of SBRT, and 11 patients (65%) had hormone-refractory (HR) disease. Treatment sites included bone (n = 19), lymph nodes (n = 1), and liver (n = 1). For patients with bone lesions, the median dose was 20 Gy (range, 8–24 Gy) in a single fraction (range, 1–3). All but two patients received some form of anti-androgen therapy after completing SBRT. Results: Local control (LC) was 100%, and the PSA nadir was undetectable in nine patients (53%). The first post-SBRT PSA was lower than pre-treatment levels in 15 patients (88%), and continued to decline or remain undetectable in 12 patients (71%) at a median follow-up of 6 months (range, 2–24 months). Median PSA measurements before SBRT and at last follow-up were 2.1 ng/dl (range, 0.13–36.4) and 0.17 ng/dl (range, <0.1–140), respectively. Six (55%) of the 11 patients with HR PCa achieved either undetectable or declining PSA at a median follow-up of 4.8 months (range, 2.2–6.0 months). Reported toxicities included one case each of grade 2 dyspnea and back pain, there were no cases of grade ≥3 toxicity following treatment. Conclusion: We report excellent LC with SBRT in oligometastatic PCa. More importantly, over half the patients achieved an undetectable PSA after SBRT. Further follow-up is necessary to assess the long-term impact of SBRT on LC, toxicity, PSA response, and clinical outcomes.
Highlights
Prostate cancer (PCa) is the most common non-skin cancer in men in the United States, with 1 in 36 men dying from the disease (American Cancer Society, 2010)
Stereotactic body radiation therapy (SBRT) uses similar techniques as central nervous system (CNS)-based stereotactic radiosurgery but treats tumors outside of the CNS using a coordinate system, which allows for limited but highly precise treatment fields. It offers some distinct advantages over conventional external beam radiation therapy (EBRT) for patients with oligometastatic cancer, including a shorter treatment course, possibly better disease control (Yamada et al, 2008), and the ability to treat in the setting of re-irradiation while sparing more normal anatomy (Sahgal et al, 2009)
We report our center’s experience from a prospective database of patients treated with SBRT for oligometastatic PCa (≤5 PCa lesions on diagnostic imaging), many of whom had previously been diagnosed with HR disease
Summary
Prostate cancer (PCa) is the most common non-skin cancer in men in the United States, with 1 in 36 men dying from the disease (American Cancer Society, 2010). Stereotactic body radiation therapy (SBRT) uses similar techniques as central nervous system (CNS)-based stereotactic radiosurgery but treats tumors outside of the CNS using a coordinate system, which allows for limited but highly precise treatment fields. It offers some distinct advantages over conventional EBRT for patients with oligometastatic cancer, including a shorter treatment course, possibly better disease control (Yamada et al, 2008), and the ability to treat in the setting of re-irradiation while sparing more normal anatomy (Sahgal et al, 2009). SBRT offers a more effective radiobiologic dose (Fowler et al, 2004)
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