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Ferriero M, Prata F, Mastroianni R, De Nunzio C, Tema G, Tuderti G, Bove AM, Anceschi U, Brassetti A, Misuraca L, Giacinti S, Calabrò F, Guaglianone S, Tubaro A, Papalia R, Leonardo C, Gallucci M, Simone G. The impact of locoregional treatments for metastatic castration resistant prostate cancer on disease progression: real life experience from a multicenter cohort. Prostate Cancer Prostatic Dis 2024; 27:89-94. [PMID: 36460734 DOI: 10.1038/s41391-022-00623-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/26/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Available data on medical treatment of metastatic castration resistant prostate cancer (mCRPC) support the use of more than one therapy line to delay chemotherapy. We evaluate in a longitudinal real life multicenter cohort, the oncological outcome of mCRPC patients treated with Abiraterone Acetate (AA) and Enzalutamide (EZ) in a chemo-naïve setting, who received locoregional treatments for subsequent development of oligorecurrent disease. METHODS We prospectively collected data on chemo-naïve mCRPC patients, who received either AA or EZ as first or second line treatment between Oct-2012 and Nov-2020 at 5 centers. High-volume disease at mCRPC onset was defined as bulky positive nodes (≥5 cm) or more than 6 bone metastases. Survival probabilities were computed at 12, 24, 48 and 60 months after treatment start. The impact of loco-regional treatments on progression free survival (PFS) were assessed with the Kaplan-Meier method and the log-rank test was applied. RESULTS Overall, 117 chemo-naive mCRPC patients received a first line therapy. Fifty-seven (48.7%) patients received AA and 60 (51.3%) received EZ. Eight (6.7%) patients underwent salvage chemotherapy after first line failure. Overall, 28 patients shifted to a second line therapy. Two-yr progression-free, cancer-specific and overall survival probabilities were 65.5%, 82.2% and 78.4% respectively. Since diagnosis of mCRPC, oligo progression occurred in 25 patients who received stereotactic radiation therapy (23/25, 92%) focused on metastasis (4 nodal sites and 19 bones) or salvage lymph node dissection (2/25, 8%). At Kaplan-Meier analysis, patients with low volume disease displayed higher PFS probabilities (log rank p = 0.009) and in this subgroup of patients loco-regional treatments had a significant impact on PFS (p = 0.048), while it was negligible in the whole cohort and in patients with high volume disease (p = 0.6 and p = 0.75). CONCLUSIONS Low-volume mCRPC patients are exposed to improved PFS and seem to benefit from locoregional treatments.
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Affiliation(s)
| | - Francesco Prata
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - Riccardo Mastroianni
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Cosimo De Nunzio
- Faculty of Health Sciences, "Sapienza" University, Ospedale Sant'Andrea, Department of Urology, Rome, Italy
| | - Giorgia Tema
- Faculty of Health Sciences, "Sapienza" University, Ospedale Sant'Andrea, Department of Urology, Rome, Italy
| | - Gabriele Tuderti
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Alfredo Maria Bove
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Umberto Anceschi
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Aldo Brassetti
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Leonardo Misuraca
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Silvana Giacinti
- Faculty of Health Sciences, "Sapienza" University, Ospedale Sant'Andrea, Department of Urology, Rome, Italy
| | - Fabio Calabrò
- San Camillo-Forlanini Hospital, Department of Medical Oncology, Rome, Italy
| | | | - Andrea Tubaro
- Faculty of Health Sciences, "Sapienza" University, Ospedale Sant'Andrea, Department of Urology, Rome, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Department of Urology, Rome, Italy
| | - Costantino Leonardo
- "Sapienza" University, Policlinico Umberto I, Department of Urology, Rome, Italy
| | - Michele Gallucci
- "Sapienza" University, Policlinico Umberto I, Department of Urology, Rome, Italy
| | - Giuseppe Simone
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
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Zamagni A, Bonetti M, Buwenge M, Macchia G, Deodato F, Cilla S, Galietta E, Strigari L, Cellini F, Tagliaferri L, Cammelli S, Morganti AG. Stereotactic radiotherapy of nodal oligometastases from prostate cancer: a prisma-compliant systematic review. Clin Exp Metastasis 2022; 39:845-863. [PMID: 35980556 PMCID: PMC9637632 DOI: 10.1007/s10585-022-10183-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/04/2022] [Indexed: 12/25/2022]
Abstract
Androgen deprivation therapy (ADT) is the standard treatment of metastatic prostate cancer (PCa). However, metastases-directed therapies can delay the initiation or switch of systemic treatments and allow local control (LC) and prolonged progression-free survival (PFS), particularly in patients with lymph nodes (LN) oligometastases. We performed a systematic review on stereotactic body radiotherapy (SBRT) in this setting. Papers reporting LC and/or PFS were selected. Data on ADT-free survival, overall survival, and toxicity were also collected from the selected studies. Fifteen studies were eligible (414 patients), 14 of them were retrospective analyses. A high heterogeneity was observed in terms of patient selection and treatment. In one study SBRT was delivered as a single 20 Gy fraction, while in the others the median total dose ranged between 24 and 40 Gy delivered in 3-6 fractions. LC and PFS were reported in 15 and 12 papers, respectively. LC was reported as a crude percentage in 13 studies, with 100% rate in seven and 63.2-98.0% in six reports. Five studies reported actuarial LC (2-year LC: 70.0-100%). PFS was reported as a crude rate in 11 studies (range 27.3-68.8%). Actuarial 2-year PFS was reported in four studies (range 30.0-50.0%). SBRT tolerability was excellent, with only two patients with grade 3 acute toxicity and two patients with grade 3 late toxicity. SBRT for LN oligorecurrences from PCa in safe and provides optimal LC. However, the long-term effect on PFS and OS is still unclear as well as which patients are the best candidate for this approach.
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Affiliation(s)
- Alice Zamagni
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy.
| | - Mattia Bonetti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Milly Buwenge
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Erika Galietta
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Lidia Strigari
- Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica ed Ematologia, Rome, Italy
- Dipartimento Universitario Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Silvia Cammelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - Bologna University, Bologna, Italy
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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