Role Of Local Treatment Research Articles

Management of oligometastatic and oligoprogressive epidermal growth factor receptor mutated non-small cell lung cancer patients: state of the art of a combined approach.

Recently, the development of targeted therapy approaches such as those based on tyrosine kinase inhibitor (TKI) greatly improved the clinical outcomes of patients affected by oncogene addicted advanced non-small cell lung cancer (NSCLC). Similarly, the improvement of radiation therapy techniques has permitted to deliver high radiation doses to a limited number of metastatic target lesions (oligopersistent or oligoprogressive), with limited high-dose normal tissue exposure that leads to low severe toxicity rates. The aim of this narrative review was to provide an overview of the currently established definition of oligometastatic and oligoprogressive disease, to define first line and subsequent lines targeted therapies and the role of consolidative non-invasive local ablative treatments (LATs) in these settings. The potential benefit of local treatment (LT) such as radiotherapy (RT) or surgery might be represented by an overall reduction of switching to subsequent systemic treatments lowering the risk of further systemic dissemination. Further randomized clinical trials will clarify the role of LT and their correct timing in relation to systemic targeted therapies.

(ARTO trial-NCT03449719): Role of local treatment after progression in patients with castrate-resistant prostate cancer undergoing first-line abiraterone treatment.

(ARTO trial-NCT03449719): Role of local treatment after progression in patients with castrate-resistant prostate cancer undergoing first-line abiraterone treatment.

Radiation Oncologists' Perspectives on Oligometastatic Disease: A Korean Survey Study.

Perspectives of radiation oncologists on oligometastatic disease was investigated using multi-layered survey. Online survey on the oligometastatic disease was distributed to the board-certified regular members of the Korean Society for Radiation Oncology. The questionnaire consisted of four domains: five questions on demographics; five on the definition of oligometastatic disease; four on the role of local therapy; and three on the oligometastatic disease classification, respectively. A total of 135 radiation oncologists participated in the survey. The median length of practice after board certification was 22.5 years (range, 1 to 44 years), and the vast majority (94.1%) answered affirmatively to the clinical experience in oligometastatic disease management. Nearly two-thirds of the respondents considered the number of involved organs as an independent factor in defining oligometastasis. Most frequently perceived upper limit on the numerical definition of oligometastasis was 5 (64.2%), followed by 3 (26.0%), respectively. Peritoneal and brain metastasis were nominated as the sites to be excluded from oligometastastic disease by 56.3% and 12.6% of the participants, respectively. Vast majority (82.1%) agreed on the role of local treatment in the management of oligometastatic disease. Majority (72%) of the participants acknowledged the European Society for Radiotherapy and Oncology (ESTRO)-European Organisation for Research and Treatment of Cancer (EORTC) classification of oligometastatic disease, however, only 43.3% answered that they applied this classification in their clinical practice. Underlying reasons against the clinical use were 'too complicated' (66.0%), followed by 'insufficient supporting evidence' (30.0%), respectively. While most radiation oncologists supported the role of local therapy in oligometastatic disease, there were several inconsistencies in defining and categorizing oligometastatic disease. Continued education and training on oligometastatic disease would be also required to build consensus among participating caregivers.

A case of malign insulinoma diagnosed with liver metastasis

Abstract Introduction Insulinoma is a rare neuroendocrine tumor originating from pancreatic beta cells and is the most common cause of hyperinsulinemic hypoglycemia. Herein, a rare case of metastatic insulinoma in which many treatment alternatives were used will be presented. Clinical Case A 52-year-old male patient with no known history of chronic disease applied to us with complaints of numbness in the hands, inability to wake up in the morning and fainting. The patient, who worked as a professional referee, stated that he went to football matches with sugar in his pocket and ate sugar when he felt bad during the football matches. The patient needed to eat many times during the day. It was learned that the patient was treated with the diagnosis of transient ischemic attack and vertigo in another hospital where he applied with these complaints. In our hospital, random glucose was determined as 30 mg/dl. Prolonged fasting test was performed. Plasma glucose: 28 md/dl, insülin: 30,81 Uıu/ml, c-peptid 6,17 ng/ml were measured at 6th hour of the test. In abdominal computarized tomography, a 6.5×9.5 cm mass in the tail section of the pancreas and a subcentimetric metastatic nodular lesion in liver were detected. The patient diagnosed with metastatic insulinoma and distal pancreatectomy and liver metastasectomy operations were performed. Pathological examination showed insulinoma in the pancreas and neuroendocrine tumor metastasis in the liver (figure 1). No hypoglycemia was seen after operation. In the postoperative 24th month, fasting plasma glucose: 176 mg/dl and HBA1c: 8.6 were found and diabetes mellitus was diagnosed, insulin detemir was started. At the postoperative 36th month, a metastatic nodular lesion was detected in the liver. Fine needle aspiration biopsy was performed and in pathological examination, neuroendocrine carcinoma metastasis is seen. Octreotide LAR 20 mg/month treatment was started. In the follow-up, another metastasis was detected in two separate foci in liver so, patient's treatment was changed to lanreotide 120 mg/month. Four sessions of radiofrequency ablation were performed to the metastatic liver lesions. The patient is still being followed up by us and has no complaints of hypoglycemia. Plasma glucose values are in the normal range and Hba1c varies between 7.1–7.6%. Conclusion Although insulinoma cases are mostly benign, metastatic cases can also be seen rarely. The main treatment of the disease is surgery. Somatostatin analogues can be used in postoperative recurrence or inoperable metastatic disease. Radiofrequency ablation has an important role in local treatment.

Lung metastases from colorectal cancer: a multidisciplinary approach and role of local treatment: a narrative review

Lung metastases from colorectal cancer: a multidisciplinary approach and role of local treatment: a narrative review

Narrative review of local prostate and metastasis-directed radiotherapy in the treatment of metastatic prostate cancer.

The role of local treatment in patients with de novo metastatic prostate cancer is controversial. In population-based retrospective studies, metastatic prostate cancer patients who received local treatment with prostate radiotherapy showed a better prognosis than those who did not. In addition, several prospective randomized studies demonstrated that prostate radiotherapy achieves a survival benefit for patients with oligo-metastasis. Moreover, the efficacy of metastasis-directed radiotherapy was evaluated, revealing a potential benefit for patients with oligo-metastasis. Importantly, these radiotherapies may reduce the occurrence of symptomatic local events. In this review, the rationale, efficacy and future perspectives for local prostate and metastasis-directed radiotherapy in the treatment of metastatic prostate cancer were described and summarized.

Role of local treatment in primary breast B-cell non-Hodgkin's lymphoma: a propensity score matching-based analysis from SEER database.

Primary breast lymphoma (PBL) has been defined as disease localized to breast with or without ipsilateral axillary nodal involvement. Primary breast B-cell non-Hodgkin's lymphoma is rare to be diagnosed clinically. The role of surgery and radiotherapy (RT) as local treatment is unclear. The aim of this study was to evaluate the prognostic factors and investigate the effect of local treatment in patients with primary breast B-cell non-Hodgkin's lymphoma. We identified patients with primary breast B-cell non-Hodgkin's lymphoma diagnosed between 1998 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to reduce possible bias between groups. The overall survival (OS) and disease-specific survival (DSS) were calculated using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify independent prognostic factors. Altogether 956 patients with primary breast B-cell non-Hodgkin's lymphoma were included. Most patients were white women over the age of 60. The most common histological type was diffuse large B cell lymphoma (DLBCL), and most patients present with stage I disease. Furthermore, old age (>60 years), DLBCL histology and stage IIE disease were the statistically significant factors associated with worse OS and DSS. Surgery did not improve survival of patients, and surgery combined with RT did not achieve a better prognosis than RT alone. RT was associated with better survival in patients with stage IE DLBCL, but patients with stage IE MZL and FL and stage IIE primary breast B-cell non-Hodgkin's lymphoma could not benefit from RT. In local treatment, surgery offered no survival benefit for patients with primary breast B-cell non-Hodgkin's lymphoma, while RT is an effective choice because it can improve both OS and DSS in the stage IE DLBCL subgroup.

Newly Diagnosed Oligometastatic Prostate Cancer: Current Controversies and Future Developments

This report presents a 56-yr-old man in good general health status, newly diagnosed with a cT3b, cN1, cM1b, International Society of Urological Pathology grade group 3, low-volume (CHAARTED criteria), low-risk (LATITUDE criteria) metastatic prostate cancer. Staging was performed with conventional imaging: a computed tomography (CT) scan showed the presence of two enlarged lymph nodes on the left, close to the external iliac vessels. In addition, a suspicious 15-mm metastatic lesion was detected in the left pubic bone. This lesion was confirmed on the bone scan, without further metastatic lesions. In the context of a clinical trial, after an initial course of androgen deprivation therapy (ADT), the patient was treated with robot-assisted radical prostatectomy and extended pelvic lymph node dissection (histopathological examination: ypT3b pN1 R1). Postprostatectomy radiation therapy was delivered on prostatic bed (70Gy), pelvic lymph node area (54Gy), and pubic bone (51Gy). ADT was scheduled for a total period of 36 mo. Currently, the patient is still receiving ADT, which will be completed within 6 mo. The last prostate-specific antigen level was undetectable. The discussion is focused on the following three open questions: (1) Would molecular imaging (eg, prostate-specific membrane antigen positron emission tomography/CT) change the therapeutic approach to the patient? (2) Is there a role for local treatment in the metastatic setting? (iii) Should metastasis-directed therapy be considered for this patient? Patient summaryThe optimal management of patients newly diagnosed with oligometastatic prostate cancer remains challenging. The fields of staging with modern imaging and therapy with novel treatment options are evolving rapidly. In particular, the role of a prostate-specific membrane antigen positron emission tomography/computed tomography scan for primary staging, the impact of a local treatment on the prostate, and the effect of direct therapies on the metastases represent important open questions in this intriguing field.

Clinical outcome of local treatment in synchronous oligometastatic non-small cell lung cancer (NSCLC): A preliminary analysis of prospective data.

e21698 Background: Advanced NSCLC is a heterogeneous disease, a large number of retrospective studies suggested that patients with oligometastases may achieve long-term survival from aggressive local treatment. However, relevant prospective studies were limited. Therefore, we prospectively evaluated the role of local treatment in synchronous oligometastatic NSCLC. Methods: We prospectively identified 50 NSCLC patients newly diagnosed with synchronous oligometastases (≤5)in two centers between 11/2017 and 12/2019, among whom there were 24 patients from a randomized clinical trial NCT03119519. Patients were given first-line systemic therapy according to the latest NCCN guidelines with either local radiotherapy or surgery to thoracic primary tumor and/or radiotherapy to metastases. They were divided into combined therapies (Tx), systemic Tx and untreated groups. Kaplan Meier Survival analysis was used to compare progression free survival (PFS) and overall survival (OS) among the groups. Results: Median age of all patients was 61 years old (range: 27-80 years) and median follow up was 5.7 months (range: 0.5-23.3 months). A total of 10 deaths were observed. In the combined Tx group, 23 patients received radiotherapy, and 2 patients received primary surgical resection. The median OS of the combined Tx group (n = 25), the systemic Tx group (n = 19) and the untreated group (n = 6) was 18.47 months, not reached, 3.27 months, respectively. Compared with the untreated group, the combined group and the systemic Tx group had better OS (hazard ratio [HR] = 0.1047, p = 0.0001; HR = 0.1125, p= 0.0006). However, the patients in the combined group did not show significant OS advantage compared with those in the systemic Tx group (HR = 1.376, p= 0.667). In addition, we conducted an ITT analysis in clinical trial NCT03119519, in which 8 progression events were observed. There was no significant difference in PFS between the combined group (n = 13) and the systemic Tx group (n = 11) (13.2 months vs. not reached, HR = 1.317, p= 0.7015; 1-year PFS: 74% vs. 54%, p = 0.7015, respectively). Conclusions: Current analysis shows that the addition of local treatment to first-line systemic Tx does not improve PFS and OS. More samples, further updated data and selection of potential beneficer are necessary. Funding: 81972853, 81572279, 2016J004, LC2019ZD009, 2018CR033. Clinical trial information: NCT03119519.

Surgical treatment of pulmonary metastases in metastatic renal cell carcinoma

Between 20 and 30 % of patients diagnosed with renal cell carcinoma suffer from metastatic disease by the time of diagnosis and a further 20 - 30 % develop metachronous metastases after initial treatment with curative intent. The therapeutic landscape of metastatic renal cell carcinoma seems be changing rapidly, with new systemic therapies or combination therapies available and established concepts being questioned because of long-awaited data. Apart from systemic therapy, metastases can be treated by surgical resection. As the most common site of metastases in renal cell carcinoma, the lung plays an important role in local treatment. Pulmonal metastasectomy is a safe procedure with low morbidity and mortality in the "right" patients. Nevertheless, there are only data from retrospective non-randomised comparative studies, which seem to show that complete metastasectomy is associated with a better prognosis and overall survival of patients. Patients with a solitary pulmonal metastasis, without involvement of hilar or mediastinal lymph nodes and a long disease-free interval after primary therapy, might benefit the most from surgery. Repeated metastasectomy can also be performed, although the data are sparse - which emphasises the need for interdisciplinary case discussions and individual therapy, as recommended in primary metastasectomy.

Brain metastases from germ cell tumor: time to reconsider radiotherapy?

The presence of brain metastases (BMs) from germ cell tumor (GCT) remains a rare situation. BMs predominantly occur among patients with testis primary tumor site, and are almost exclusively associated with non-seminomatous (NS) histologies. Two situations must be distinguished, which differ in terms of clinical presentation, overall prognostic and management. At diagnosis, BMs are almost systematically associated with extra-cerebral metastases and the cornerstone of treatment is chemotherapy, while the role of local treatment remains controversial. In the metachronous setting, BMs more frequently constitute an isolated site of relapse, the outcome is poorer, and the role of local treatment is more consensual. However, all these data widely come from old reports, with outdated radiation techniques. The recent advances in radiation oncology, especially the rising use of stereotactic radiotherapy, could lead to the reconsideration of ancient dogmas regarding the "radiosensitivity" of (NS)GCT and the role of radiotherapy among patients with BMs.

Short-term therapeutic outcomes of robotic-assisted laparoscopic radical prostatectomy for oligometastatic prostate cancer: a propensity score matching study.

BackgroundThe role of local treatment in oligometastatic prostate cancer (PCa) is gaining interest with the oligometastases hypothesis proposed and the improvement of various surgical methods and techniques. This study aimed to compare the short-term therapeutic outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP) for oligometastatic prostate cancer (OPC) vs. localized PCa using propensity score matching.MethodsTotally 508 consecutive patients underwent RALP as a first-line treatment. The patients were divided into two groups according to oligometastatic state: the OPC group (n = 41) or the localized PCa group (n = 467). Oligometastatic disease was defined as the presence of two or fewer suspicious lesions. The association between the oligometastatic state and therapeutic outcomes of RALP was evaluated, including biochemical recurrence (BCR) and overall survival (OS). A Cox proportional hazards model was used to assess the possible risk factors for BCR.ResultsTotally 41 pairs of patients were matched. The median operative time, the median blood loss, the overall positive surgical margin rate, the median post-operative hospital stays, and the post-operative urinary continence recovery rate between the two groups showed no statistical significance. The 4-year BCR survival rates of the OPC group and localized PCa group were 56.7% and 60.8%, respectively, without a significant difference (P = 0.804). The 5-year OS rates were 96.3% and 100%, respectively (P = 0.326). Additionally, the results of Cox regression showed that oligometastatic state was not an independent risk factor for BCR (P = 0.682).ConclusionsOur findings supported the safety and effectiveness of RALP in OPC. Additionally, oligometastatic state and sites did not have an adverse effect on BCR independently.

The Role of Local Treatment in Oligometastatic and Oligoprogressive Cancer.

Systemic treatment is standard for most types of cancer with disseminated metastases. The role of local treatment (LT) of individual tumor foci in patients with oligometastatic disease is unclear and the object of current scientific studies. This review is based on pertinent publications retrieved by a selective search in PubMed. Four randomized trials have shown that radical local treatment confers an advantage with respect to overall survival (OS), compared to systemic treatment alone, in patients with oligometastatic disease. In patients with synchronous metastases and a stable primary tumor, LT prolongs the median overall survival by approximately two years. A single randomized trial for oligometastatic small-cell lung cancer did not show any prolongation of overall survival. Local treatment increased the frequency of grade III side effects by approximately 10%. Although local treatment already has a place in many guidelines on the basis of the findings of a small number of prospective and retrospective studies, a option of local treatment should be considered by an interdisciplinary tumor board individually for suitable patients.

PO-0790 A nationwide analysis evaluating a role of local treatment including external RT for BCLC C HCCs

PO-0790 A nationwide analysis evaluating a role of local treatment including external RT for BCLC C HCCs

Immunohistochemical evaluation after Sr-enriched biphasic ceramic implantation in rabbits femoral neck: comparison of seven different bone conditions.

Strontium (Sr) has shown effectiveness for stimulating bone remodeling. Nevertheless, the exact therapeutic values are not established yet. Authors hypothesized that local application of Sr-enriched ceramics would enhance bone remodeling in constant osteoporosis of rabbits' femoral neck bone. Seven different bone conditions were analyzed: ten healthy rabbits composed a control group, while other twenty underwent ovariectomy and were divided into three groups. Bone defect was filled with hydroxyapatite 30% (HAP) and tricalcium phosphate 70% (TCP) granules in 7 rabbits, 5% of Sr-enriched HAP/TCP granules in 7, but sham defect was left unfilled in 6 rabbits. Bone samples were obtained from operated and non-operated legs 12 weeks after surgery and analyzed by histomorphometry and immunohistochemistry (IMH). Mean trabecular bone area in control group was 0.393 mm2, in HAP/TCP - 0.226 mm2, in HAP/TCP/Sr - 0.234 mm2 and after sham surgery - 0.242 mm2. IMH revealed that HAP/TCP/Sr induced most noticeable increase of nuclear factor kappa beta 105 (NFkB 105), osteoprotegerin (OPG), osteocalcin (OC), bone morphogenetic protein 2/4 (BMP 2/4), collagen type 1α (COL-1α), interleukin 1 (IL-1) with comparison to intact leg; NFkB 105 and OPG rather than pure HAP/TCP or sham bone. We concluded that Sr-enriched biomaterials induce higher potential to improve bone regeneration than pure bioceramics in constant osteoporosis of femoral neck bone. Further studies on bigger osteoporotic animals using Sr-substituted orthopedic implants for femoral neck fixation should be performed to confirm valuable role in local treatment of osteoporotic femoral neck fractures in humans.

Outcomes of Surgery as Part of the Management of Metastatic Non–Small-Cell Lung Cancer: A Surveillance, Epidemiology and End Results Database Analysis

ABSTRACTThe role of local treatment in patients with oligometastatic non–small-cell lung cancer (NSCLC) is a subject of ongoing debate. This study assessed the survival impact of combined surgery to the primary tumor and metastatic disease in the management of metastatic NSCLC. Stage IV NSCLC patients at presentation, diagnosed from 2004 to 2013 were identified from the SEER (Surveillance, Epidemiology, and End Results) database. Propensity-matched analysis was performed considering baseline characteristics (age, gender, race, histology, TN stage, and site of metastases).A total of 144,334 patients were identified. The median age group was 65–70 years, and 1139 patients (0.8% of the patients) have received surgical treatment to both the primary tumor and metastatic disease. Both before and after propensity score matching, cancer-specific and overall survival were better in the surgical therapy group (P < 0.0001 for all). When the analysis was restricted to the subsets of patients with brain only M1 disease or isolated contra lateral nodule, overall survival was improved by combined surgery. However, in multivariate analysis of the overall population (postmatching), combined surgery was not associated with a better overall survival (0.576).Despite the apparently beneficial role of surgery in this study for some patients with metastatic disease, the absence of adequate information about systemic therapy as well as associated comorbidity hinders the generation of definite conclusions. Prospective studies are needed to confirm the role of surgery in the setting of metastatic disease.

The role of definitive local treatment in metastatic hepatocellular carcinoma patients: A SEER-based study.

In the present study, we aimed to investigate the survival benefit from definitive local treatment (LT) for hepatocellular carcinoma patients with distant metastasis (mHCC).We retrospectively analyzed mHCC patients from Surveillance, Epidemiology, and End Results (SEER) Database. The patients' clinical and pathological characteristics were analyzed. Overall survival (OS) was calculated by Kaplan-Meier method. Independent risk factors associated with disease special mortality (DSM) were identified by multivariable regression analysis.A total of 7187 mHCC patients from SEER database were identified. A total of 258 (3.6%) patients had received surgery treatment (ST), 64 (0.9%) patients underwent radiotherapy (RT), and 6865 (95.5%) patients were identified to no surgery or radiation therapy group (NSR). Compared with the patients in NSR group, patients who received ST (hazard ratio [HR]: 0.26, 95% confidence interval [CI] 0.22-0.31, P < .001) and RT (HR: 0.51, 95% CI 0.38-0.67, P < .001) had decreased DSM. Patients with age >50 years, female, and T3 or higher stage were associated with increased DSM.The present study demonstrated the survival benefit of definitive LT in mHCC patients. However, a large randomized clinical trial to validate the role of LT in mHCC is necessary in the future.

Adenoid cystic carcinoma of the nasopharynx: a case report and a discussion about prognostic factors and the role of local treatments.

Adenoid cystic carcinoma (ACC) is a rare epithelioid malignancy. It occurs most frequently in the salivary glands, while its localization in the nasopharynx is rare and few cases have been reported in the literature. We report the case of a 32-year-old woman presenting with ACC of the nasopharynx who was treated with surgery and adjuvant intensity-modulated radiation therapy (IMRT, total dose: 68 Gy) and concomitant chemotherapy (cisplatin 100 mg/m² on the first and 21st days of IMRT). During irradiation, the patient developed G1 dermatitis and G2 mucositis (RTOG). Clinical and instrumental reevaluation 17 months after the end of radiotherapy did not show any signs of relapse, and she did not show any sign of local mild-severe toxicity. Adjuvant radiotherapy after standard complete surgical resection seems to be effective and well tolerated and should be strongly considered in the multidisciplinary approach to this infrequent carcinoma.

MP53-18 EFFICACY OF LOCAL TREATMENT IN PROSTATE CANCER PATIENTS WITH CLINICALLY PELVIC LYMPH NODE-POSITIVE DISEASE AT INITIAL DIAGNOSIS

Abstract Background There is limited evidence supporting the use of local treatment (LT) for prostate cancer (PCa) patients with clinically pelvic lymph node-positive (cN1) disease. Objective To examine the efficacy of any form of LT±androgen deprivation therapy (ADT) in treating these individuals. Design, setting, and participants Using the National Cancer Database (2003–2011), we retrospectively identified 2967 individuals who received LT±ADT versus ADT alone for cN1 PCa. Only radical prostatectomy (RP) and radiation therapy (RT) were considered as definitive LT. Intervention LT±ADT versus ADT alone. Outcome measurements and statistical analysis Instrumental variable analyses (IVA) were performed using a two-stage residual inclusion approach to compare overall mortality (OM)-free survival between patients who received LT±ADT versus ADT alone. The same methodology was used to further compare OM-free survival between patients who received RP±ADT versus RT±ADT. Results and limitations Overall, 1987 (67%) and 980 (33%) patients received LT±ADT and ADT alone, respectively. In the LT±ADT group, 751 (37.8%) and 1236 (62.2%) patients received RP±ADT and RT±ADT, respectively. In IVA, LT±ADT was associated with a significant OM-free survival benefit (hazard ratio=0.31, 95% confidence interval [CI]=0.13–0.74, p =0.007), when compared with ADT alone. At 5 yr, OM-free survival was 78.8% (95% CI: 74.1–83.9%) versus 49.2% (95% CI: 33.9–71.4%) in the LT±ADT versus ADT alone groups. When comparing RP±ADT versus RT±ADT, IVA showed no significant difference in OM-free survival between the two treatment modalities (hazard ratio=0.54, 95% CI=0.19–1.52, p =0.2). Despite the use of an IVA, our study may be limited by residual unmeasured confounding. Conclusions Our findings show that PCa patients with clinically pelvic lymph node-positive disease may benefit from any form of LT±ADT over ADT alone. While not necessarily curative by itself, the use of RP or RT could be the first step in a multi-modality approach aiming at providing the best cancer control outcomes for these individuals. Patients summary We examined the role of local treatment for clinically pelvic lymph node-positive prostate cancer. We found that the delivery of radical prostatectomy or radiation therapy may be associated with an overall mortality-free survival benefit compared with androgen deprivation therapy alone.

Radical Prostatectomy in Men with Oligometastatic Prostate Cancer: Results of a Single-institution Series with Long-term Follow-up

In the absence of data from randomized trials, the role of local treatment in metastatic prostate cancer (PCa) is gaining interest. Our study aimed to assess perioperative and long-term oncologic outcomes of radical prostatectomy (RP) in a selected cohort of 11 patients with oligometastatic disease treated with RP and extended pelvic lymph node dissection between 2006 and 2011. Oligometastatic disease was defined as the presence of five or fewer bone lesions at bone scan with or without suspicious pelvic or retroperitoneal nodal involvement at preoperative imaging. The minimum follow-up for survivors was 5 yr. Perioperative outcomes, clinical progression, and cancer-specific mortality (CSM) were evaluated. Median age was 72 yr. Median operative time, blood loss, and length of hospitalization were 170min, 750ml, and 13 d, respectively. Overall, two patients (18%) experienced grade 3 complications in the postoperative period, and eight (73%) received blood transfusions. Overall, 10 (91%) and 8 (73%) patients had lymph node invasion and positive surgical margins, respectively. Adjuvant androgen deprivation therapy was administered to 10 patients (91%). Median follow-up for survivors was 63 mo. The 7-yr clinical progression- and CSM-free survival rates were 45% and 82%, respectively. Our findings support the safety and effectiveness of RP in a highly selected cohort of PCa patients with bone metastases and long-term follow-up. Patient summaryWe evaluated the outcomes of patients with oligometastatic prostate cancer treated with radical prostatectomy with a minimum of 5-yr follow-up. This surgical procedure performed with a multimodal approach might represent a safe and feasible option in selected men and provide acceptable oncologic outcomes at long-term follow-up.