Cytoreductive prostate radiotherapy in oligometastatic prostate cancer: a single centre analysis of toxicity and clinical outcome

摘要

Objectives: The current standard of care for patients with metastatic prostate cancer (mPCa) at diagnosis is androgen deprivation therapy(ADT) with or without anti-androgen and chemotherapy. The aim of this study was to define the role of a local radiotherapy (RT) treatmentin the mPCa setting.Methods: We retrospectively reviewed data of patients with PCa and bone oligometastases at diagnosis treated in our institution with ADTfollowed by cytoreductive prostate-RT with or without RT on metastases. Biochemical and clinical failure (BF, CF), overall survival (OS) andRT-toxicity were assessed.Results: We identified 22 patients treated with ADT and external-beam RT on primary between June 2008 and March 2016. All of thembut four were also treated for bone metastases. RT on primary with moderately and extremely hypofractionated regimes started after 10.3months (3.9–51.7) from ADT. After a median follow-up of 26.4 months (10.3–55.5), 20 patients are alive. Twelve patients showed BF aftera median time of 23 months (14.5–104) and CF after a median of 23.6 months (15.3–106.1) from the start of ADT. Three patients becamecastration resistant, starting a new therapy; median time to castration resistance was 31.03 months (range: 29.9–31.5 months). Accordingto the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC), only onepatient developed acute grade 3 genitourinary toxicity. No late grade >2 adverse events were observed.Conclusion: Prostate RT in oligometastatic patients is safe and offers long-lasting local control. When compared to ADT alone, RT onprimary seems to improve biochemical control and long-term survival; however, this hypothesis should be investigated in prospective studies.Further research is warranted.