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López-Campos F, Conde-Moreno A, Barrado Los Arcos M, Gómez-Caamaño A, García-Gómez R, Hervás Morón A. Treatment Landscape of Nonmetastatic Castration-Resistant Prostate Cancer: A Window of Opportunity. J Pers Med 2021; 11:1190. [PMID: 34834544 PMCID: PMC8619952 DOI: 10.3390/jpm11111190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
The treatment for nonmetastatic castration-resistant prostate cancer (nmCRPC) is a highly unmet medical need. The classic treatment approach for these patients-androgen deprivation therapy (ADT) alone-until metastatic progression is now considered suboptimal. Several randomized phase III clinical trials have demonstrated significant clinical benefits-including significantly better overall survival (OS)-for treatments that combine ADT with apalutamide, enzalutamide, and darolutamide. As a result, these approaches are now included in treatment guidelines and are considered a standard of care. In the present article, we discuss the changing landscape of the management of patients with nmCRPC.
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Affiliation(s)
- Fernando López-Campos
- Deparment Radiation Oncology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Antonio Conde-Moreno
- Deparment Radiation Oncology, Hospital Universitario y Politécnico La Fe, 46010 Valencia, Spain;
| | | | - Antonio Gómez-Caamaño
- Deparment Radiation Oncology, Hospital Clínico Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | - Raquel García-Gómez
- Deparment Radiation Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Asunción Hervás Morón
- Deparment Radiation Oncology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
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Gomez-Iturriaga A, Casquero Ocio F, Ost P, Fernandez I, Rodeño E, Llarena R, Garcia-Olaverri J, Ortiz de Zarate R, Cacicedo J, Ahtamon A, Bilbao P. Outcomes after a first and/or second salvage treatment in patients with oligometastatic prostate cancer recurrence detected by (18-F) choline PET-CT. Eur J Cancer Care (Engl) 2019; 28:e13093. [PMID: 31115124 DOI: 10.1111/ecc.13093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 11/28/2018] [Accepted: 04/12/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The primary objective of this study was to assess clinical outcomes in patients with oligometastatic prostate cancer recurrence after single or repeated salvage radiation treatment. METHODS Forty-nine consecutive prostate cancer patients diagnosed with oligometastatic recurrence on Ch-PET have been prospectively treated. Seven (23%) patients had castrate-resistant disease. Clinical outcomes were assessed using the Kaplan-Meier method. Potential prognostic factors were examined using univariate proportional hazards regression. RESULTS The treatments administered to the initial oligorecurrence sites were intensity-modulated radiotherapy (IMRT) ± ADT (26 patients; 53%) and stereotactic ablative radiotherapy (SABR) ± ADT (23 patients; 47%). With a median follow-up of 24 months (range 6-39), 24 patients developed a biochemical failure. Twenty out of the 24 relapsed patients underwent a second Ch-PET/CT. Seven patients presented poly-metastatic relapse and 10 oligometastatic diseases. Six of 10 patients with a second oligorecurrence were treated again with SABR. Overall, 102 lesions were treated. Local control was detected in 45 (91.8%) patients. No relevant (grade ≥ 2) toxicity was reported, and there was no grade 3 toxicity. On univariate analysis, none of the variables were significantly predicted for clinical disease-free survival. At last follow-up visit, 24 patients (40%) were free from biochemical failure and 37 (71%) patients were free from clinical disease. The 2-year OS and PCSS were 91.8% and 95.9% respectively. CONCLUSION Salvage IMRT or SBRT of oligometastatic prostate cancer recurrence is associated with a prolonged cDFS. This may result in a longer time to develop castrate-resistant disease and a longer time without systemic therapies.
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Affiliation(s)
- Alfonso Gomez-Iturriaga
- Department of Radiation Oncology, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
| | - Francisco Casquero Ocio
- Department of Radiation Oncology, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Iratxe Fernandez
- Department of Nuclear Medicine, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
| | - Emilia Rodeño
- Department of Nuclear Medicine, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
| | - Roberto Llarena
- Department of Urology, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
| | - Jorge Garcia-Olaverri
- Department of Urology, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
| | - Roberto Ortiz de Zarate
- Department of Radiation Oncology, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
| | - Jon Cacicedo
- Department of Radiation Oncology, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
| | - Alina Ahtamon
- Department of Radiation Oncology, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
| | - Pedro Bilbao
- Department of Radiation Oncology, Hospital Universitario Cruces, Biocruces Health Research Institute, Barakaldo, Spain
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Okonogi N, Kaminuma T, Okimoto T, Shinoto M, Yamamoto N, Yamada S, Murata K, Ohno T, Shioyama Y, Tsuji H, Nakano T, Kamada T. Carbon-ion radiotherapy for lymph node oligo-recurrence: a multi-institutional study by the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS). Int J Clin Oncol 2019; 24:1143-1150. [PMID: 30968270 PMCID: PMC6687700 DOI: 10.1007/s10147-019-01440-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/02/2019] [Indexed: 01/09/2023]
Abstract
Background The efficacy of carbon-ion radiotherapy (C-ion RT) for lymph node (LN) oligo-recurrence has only been evaluated in limited single-center studies. We aimed to investigate the benefit of C-ion RT for LN oligo-recurrence in a large multi-center study. Methods Patients who received C-ion RT between December 1996 and December 2015 at 4 participating facilities and who met the following eligibility criteria were included: (i) histological or clinical diagnosis of LN recurrence; (ii) controlled primary lesion; (iii) no recurrence other than LN; (iv) LN recurrence involved in a single lymphatic site; and (v) age ≥ 20 years. Results A total of 323 patients were enrolled. Median follow-up period was 34 months for surviving patients. The most common dose fractionation of C-ion RT was 48.0 Gy (relative biological effectiveness) in 12 fractions. Forty-seven patients had a history of RT at the recurrent site. The 2-year local control (LC) and overall survival (OS) rates after C-ion RT were 85% and 63%, respectively. Only 1 patient developed grade-3 toxicity. Factors such as LN diameter, histology, and history of previous RT did not correlate with LC. Smaller diameters (< 30 mm) and numbers (≤ 3) of LN metastases as well as longer disease-free intervals post-primary therapy (≥ 16 months) were associated with significantly better OS. Conclusions C-ion RT for LN oligo-recurrence appeared to be effective and safe. C-ion RT may provide a survival benefit to patients with LN oligo-recurrence, particularly to those with few LN metastases, smaller LN diameters, and longer disease-free intervals. Electronic supplementary material The online version of this article (10.1007/s10147-019-01440-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Takuya Kaminuma
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan
| | - Makoto Shinoto
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Saga, Japan
| | - Naoyoshi Yamamoto
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Kazutoshi Murata
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | | | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Kamada
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
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Palacios-Eito A, Béjar-Luque A, Rodríguez-Liñán M, García-Cabezas S. Oligometastases in prostate cancer: Ablative treatment. World J Clin Oncol 2019; 10:38-51. [PMID: 30815370 PMCID: PMC6390116 DOI: 10.5306/wjco.v10.i2.38] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/30/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
Technological advances in radiotherapy have led to the introduction of techniques such as stereotactic body radiation therapy (SBRT), allowing the administration of ablative doses. The hypothesis that oligometastatic disease may be cured through local eradication therapies has led to the increasing use of SBRT in patients with this type of disease. At the same time, scientific advances are being made to allow the confirmation of clinically suspected oligometastatic status at molecular level. There is growing interest in identifying patients with oligometastatic prostate cancer (PCa) who may benefit from curative intent metastasis-directed therapy, including SBRT. The aim is to complement, replace or delay the introduction of hormone therapy or other systemic therapies. The present review aims to compile the evidence from the main ongoing studies and results on SBRT in relation to oligometastatic PCa; examine aspects where gaps in knowledge or a lack of consensus persist (e.g., optimum schemes, response assessment, identification and diagnosis of oligometastatic patients); and document the lack of first-level evidence supporting the use of such techniques.
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Affiliation(s)
- Amalia Palacios-Eito
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Amelia Béjar-Luque
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
| | | | - Sonia García-Cabezas
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba 14004, Spain
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Volumetric modulated arc therapy for thoracic node metastases: a safe and effective treatment for a neglected disease. Oncotarget 2018; 7:53321-53329. [PMID: 27462869 PMCID: PMC5288189 DOI: 10.18632/oncotarget.10826] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/30/2016] [Indexed: 12/29/2022] Open
Abstract
Purpose To evaluate the outcome of Stereotactic Body Radiation Therapy (SBRT) with Volumetric Modulated Arc Therapy (VMAT) for thoracic node metastases. Results 18 out of 29 patients presented with isolated thoracic node metastases with no other sites of disease. Median prescribed dose was 45Gy (range 30–60Gy). Acute toxicity was recorded as G0 in 28 patients, while one patient was scored as G1. Late toxicity was G0 in 26 patients, one patient was scored G1, one as G2, and one as G4 presented acute myocardial infarction. During follow up, the best local response was complete remission in 14 patients and partial remission in 11 patients. With a median follow up of 12 months (range 2–35) 9 patients died from disease progression, 10 were still alive with distant metastases, 5 had a locally controlled disease and 5 patients were disease free. The median OS estimated was 18 months (76%, 49% at one, two years). The median PFS was 9 months (28%, 17% at one, two years). Materials and Methods Twenty-nine patients with 32 thoracic nodes metastases were treated with SBRT in our institution. Toxicities and response were assessed. Overall Survival (OS) and Progression Free Survival (PFS) were evaluated. Conclusions SBRT is an efficient treatment for thoracic node metastases.
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Matsushita H, Jingu K, Umezawa R, Yamamoto T, Ishikawa Y, Takahashi N, Katagiri Y, Kadoya N. Stereotactic Radiotherapy for Oligometastases in Lymph Nodes-A Review. Technol Cancer Res Treat 2018; 17:1533033818803597. [PMID: 30352542 PMCID: PMC6201169 DOI: 10.1177/1533033818803597] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 01/26/2023] Open
Abstract
In recent years, the concept of oligometastases has become accepted and reports on stereotactic body radiotherapy as a treatment method have been published. Lesions in the brain, lung, and liver have been reported as target lesions. However, lymph node oligometastases could be a good candidate for stereotactic body radiotherapy as well. In this study, the usability of stereotactic body radiotherapy for oligometastases to lymph nodes is assessed by researching for each primary site. As a result, we could consider that stereotactic body radiotherapy could be almost well applied for lymph node oligometastases from the breast, gynecological organs, and prostate. However, doubts remain concerning the usefulness of stereotactic body radiotherapy for cervical node metastases from head and neck cancer or for mediastinal node metastases from lung or esophageal cancer since late toxicities have occurred with a large radiation dose at hypofractionation to major vessels or the central respiratory tract, especially in patients with irradiation histories. In addition, high-dose irradiation is required to control lymph node metastases from colorectal cancer due to its radioresistance, and severe late adverse events would therefore occur in adjacent organs such as the gastrointestinal tract. In cases of lymph node oligometastases with a primary tumor in the stomach or esophagus, stereotactic body radiotherapy should be used limitedly at present because this patient population is not so large and these metastases are often located close to organs at risk. Because of the varied status of recurrence and varied conditions of patients, it is difficult to determine the optimal dose for tumor control. It might be reasonable to determine the treatment dose individually based on dose constraints of adjacent organs. The oligometastatic state is becoming more frequently identified with more sensitive methods of detecting such oligometastases. In addition, there seems to be another type of oligometastases, so-called induced oligometastases, following successful systemic treatment. To determine the optimal indication of stereotactic body radiotherapy for lymph node oligometastases, further investigation about the mechanisms of oligometastases and further clinical studies including a phase III study are needed.
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Affiliation(s)
- Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Yu Katagiri
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of
Medicine, Sendai, Japan
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Yeung R, Hamm J, Liu M, Schellenberg D. Institutional analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lymph node metastases. Radiat Oncol 2017; 12:105. [PMID: 28637480 PMCID: PMC5480150 DOI: 10.1186/s13014-017-0820-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/08/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In limited metastatic burden of disease, stereotactic body radiotherapy (SBRT) has been shown to achieve high local control rates. It has been hypothesized that SBRT may translate to a better quality of life by delaying the need for systemic chemotherapy and possibly increasing survival. There is limited published literature on the efficacy of SBRT in limited nodal metastases. The primary aim is to review institutional outcomes of patients with solitary or oligometastatic lymph nodes treated with SBRT. METHODS A retrospective study of patients treated with SBRT to metastatic lymph nodes (March 2010-June 2015) was conducted. Endpoints of this study were local control (LC), chemotherapy-free survival (CFS) following SBRT, toxicities, progression free survival (PFS), and overall survival (OS). RESULTS Eighteen patients with a mean age of 65 years underwent SBRT to metastatic lymph nodes. Median follow-up was 33.6 months. There were four hepatocellular carcinoma, seven colorectal, four pancreatic, one esophageal, one gallbladder and one lung primary. Eleven (61%) patients had lymph node metastases at initial presentation of metastatic disease. Seven patients (39%) had systemic therapy prior to SBRT, with five patients receiving two lines of chemotherapy. Eight patients had solitary metastatic disease at the time of radiotherapy. All patients had <5 metastases. Median size of lymph node metastases was 1.95 cm (range: 0.8-6.2 cm). RT doses were 31 to 60 Gy in four to ten fractions, with 44% of patients receiving 35 Gy in 5 fractions. At 1 year, LC was 94% and CFS from SBRT was 60%. One-year PFS and OS were 39% and 89% respectively. There were no grade 3 or higher toxicities. CONCLUSIONS In this single institution study, SBRT to oligometastatic lymph nodes provided excellent LC and a moderate chemotherapy-free interval with minimal toxicities. Disease progression remains prominent in these patients and larger studies are warranted to identify those who benefit most from SBRT.
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Affiliation(s)
- Rosanna Yeung
- Department of Radiation Oncology, British Columbia Cancer Agency- Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6 Canada
| | - Jeremy Hamm
- Cancer Surveillance and Outcomes, British Columbia Cancer Agency, 703-686 West Broadway, Vancouver, BC V5Z 4C1 Canada
| | - Mitchell Liu
- Department of Radiation Oncology, British Columbia Cancer Agency- Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6 Canada
| | - Devin Schellenberg
- Department of Radiation Oncology, British Columbia Cancer Agency- Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6 Canada
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