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Persson AE, Hallqvist A, Bjørn Larsen L, Rasmussen M, Scherman J, Nilsson P, Tønnesen H, Gunnlaugsson A. Stereotactic body radiotherapy as metastasis-directed therapy in oligometastatic prostate cancer: a systematic review and meta-analysis of randomized controlled trials. Radiat Oncol 2024; 19:173. [PMID: 39690404 DOI: 10.1186/s13014-024-02559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 11/12/2024] [Indexed: 12/19/2024] Open
Abstract
BACKGROUND The use of stereotactic body radiotherapy (SBRT) to definitively treat oligometastases in prostate cancer has drawn large clinical and research interests within radiation oncology. However, the evidence is considered in its early stages and there is currently no systematic review of randomized controlled trials (RCTs) in this field. We aimed to evaluate the efficacy and safety of SBRT as metastasis-directed therapy (MDT) in oligometastatic prostate cancer (OMPC) compared to no MDT reported in RCTs. METHODS MEDLINE, Embase, CINAHL Complete, and Cochrane Library were searched on October 28, 2023. Eligible studies were RCTs comparing SBRT as MDT with no MDT in extracranial OMPC, without restrictions on follow-up time, publication status, language, or year. Participant subsets fulfilling the eligibility criteria were included. Critical outcomes were overall survival and grade ≥ 3 toxicity, and additional important outcomes were progression-free survival (PFS), local control, grade 5 toxicity, health-related quality of life, and systemic therapy-free survival. Meta-analyses were planned. Risk of bias was assessed using the Cochrane risk-of-bias tool version 2, and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS In total, 1825 unique study reports were identified and seven phase II RCTs with 559 eligible participants were included. Four trials included multiple types of primary cancer. Outcome definitions were heterogeneous except for overall survival and toxicity. For overall survival, only one study reported events in both arms. Meta-analysis of the grade ≥ 3 toxicity results from two trials showed no difference (pooled risk ratio 0.78, 95% confidence interval 0.37-1.65, p = 0.52). Four trials reported significantly longer PFS, with a pooled hazard ratio of 0.31 (95% confidence interval 0.21-0.45, p < 0.00001). Risk of bias was of some concerns or high. Quality of evidence was low or moderate. CONCLUSIONS Phase II trials have shown promising improvements in PFS for several OMPC states without excess toxicity. Overall survival comparisons are immature. In future confirmatory phase III trials, adequately large sample sizes, blinding of outcome assessors, and/or increased adherence to assigned intervention could improve the quality of evidence. PROSPERO registration number: CRD42021230131.
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Affiliation(s)
- Astrid E Persson
- Division of Oncology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden.
| | - Andreas Hallqvist
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Louise Bjørn Larsen
- Department of Oncology, Herlev Hospital, Copenhagen University Hospitals, Herlev, Denmark
| | - Mette Rasmussen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Lund, Sweden
| | - Jonas Scherman
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Per Nilsson
- Division of Oncology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Lund, Sweden
- Clinical Health Promotion Centre, WHO Collaborating Centre, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University, Copenhagen, Frederiksberg, Denmark
| | - Adalsteinn Gunnlaugsson
- Division of Oncology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Oertel M, Scobioala S, Kroeger K, Baehr A, Stegger L, Haverkamp U, Schäfers M, Eich HT. Worth a local treatment? - Analysis of modern radiotherapy concepts for oligometastatic prostate cancer. Radiat Oncol 2018; 13:185. [PMID: 30241556 PMCID: PMC6150968 DOI: 10.1186/s13014-018-1118-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/29/2018] [Indexed: 12/03/2022] Open
Abstract
Background Prostate cancer (PCA) is the most-prevalent non-skin cancer in men worldwide. Nevertheless, the treatment of oligometastatic, especially lymph-node (ln) recurrent, PCA remains elusive. The aim of our study was to provide insights in radiotherapy (RT)-treatment of recurrent PCA exhibiting ln- or osseous (oss)-oligometastases. Methods Between April 2012 and April 2017, 27 oligometastatic PCA patients (19 ln and 8 single oss) were treated with RT at our institution. Results The metastasis-free survival (MFS) was 24.8 m (22.0–36.0 m) and 25.4 m (23.9–28.1 m) for the ln- and oss-subgroup resulting in 1-year MFS of 75.4 and 100% and 2-year MFS of 58.7 and 83.3% for ln- and oss-metastatic patients, respectively. Of notice, none of the recurrences for ln-patients was in the RT-field, constituting a local control of 100%. Within the ln-group, pre-RT median-PSA was 2.6 ng/ml, median post-RT PSA was 0.3 ng/ml, which was significant (p = 0.003). Median biochemical-free survival (bfS) was 12.2 m. PCA that was initially confined to the prostate had a better bfS (p < 0.001) and MFS (p = 0.013). The oss-group had a median PSA of 4.9 ng/ml pre-treatment which dropped to a median value of 0.14 ng/ml (p = 0.004). Toxicities were moderate, with only 1 case of III° toxicity. There were no deaths in the ln-group, thus overall survial was 100% here. Conclusion Our study points out the feasibility of RT as a treatment option in recurrent PCA and demonstrates an excellent local control with a low-toxicity profile.
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany.
| | - S Scobioala
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - K Kroeger
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - A Baehr
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - L Stegger
- Department of Nuclear Medicine, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - U Haverkamp
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - M Schäfers
- Department of Nuclear Medicine, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
| | - H-T Eich
- Department of Radiation Oncology, Albert-Schweitzer Campus 1 A1, 48149, Muenster, Germany
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