Does Radiotherapy for the Primary Tumor Benefit Prostate Cancer Patients with Distant Metastasis at Initial Diagnosis?

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2016 Jan 26

PMID 26807740

Citations 26

Authors

Yeona Cho

Jee Suk Chang

Koon Ho Rha

Sung Joon Hong

Young Deuk Choi

Won Sik Ham

Jun Won Kim

Jaeho Cho

Affiliations

Soon will be listed here.

Abstract

Purpose/objectives: Treatment of the primary tumor reportedly improves survival in several types of metastatic cancer. We herein evaluated the efficacy and toxicity of radiotherapy for the primary tumor in prostate cancer with metastasis.

Materials/methods: The study cohort included 140 men with metastatic prostate cancer at initial diagnosis. Metastatic sites were divided into 4 groups as follows: solitary bone, 2-4 bones, ≥5 bones, and visceral organs. Patient, tumor, and treatment characteristics, and clinical outcomes were compared between patients treated with (prostate radiotherapy [PRT] group) or without radiotherapy to the primary tumor.

Results: Patients in PRT group presented with a statistically significantly younger age (p = .02), whereas other characteristics showed no significant difference. Overall survival (OS) and biochemical failure-free survival (BCFFS) were improved in PRT patients (3-year OS: 69% vs. 43%, p = 0.004; 3-year BCFFS: 52% vs. 16%, p = 0.002). Multivariate analysis identified PRT as a significant predictor of both OS (hazard ratio [HR] = 0.43, p = 0.015). None of the 38 PRT patients experienced severe (grade ≥3) genitourinary or gastrointestinal toxicity.

Conclusions: Our data suggest that radiotherapy to the primary tumor was associated with improved OS and BCFFS in metastatic prostate cancer. The results of this study warrant prospective controlled clinical trials of this approach in stage IV prostate cancer patients with limited extent of bone metastasis and good performance status.

Citing Articles

The Impact of Radiotherapy on the Primary Tumor in Patients with Metastatic High-Volume Castration-Sensitive Prostate Cancer: A Propensity Score Matching Analysis.

Skripai A, Blumenfeld P, Krakow A, Den R, Popovtzer A, Wygoda M Cancers (Basel). 2025; 17(2).

PMID: 39858079 PMC: 11763697. DOI: 10.3390/cancers17020297.

A Personalized Approach for Oligometastatic Prostate Cancer: Current Understanding and Future Directions.

Alerasool P, Zhou S, Miller E, Anker J, Tsao B, Kyprianou N Cancers (Basel). 2025; 17(1).

PMID: 39796774 PMC: 11720581. DOI: 10.3390/cancers17010147.

The Role of Local Prostate and Metastasis-Directed Radiotherapy in the Treatment of Oligometastatic Prostate Cancer.

Choi S, Beom S, Choi Y, Ham W, Han H, Han W Cancers (Basel). 2024; 16(18).

PMID: 39335131 PMC: 11429795. DOI: 10.3390/cancers16183159.

Radical prostatectomy versus radiotherapy as local therapy for primary tumors in patients with oligometastatic prostate cancer.

Ham W, Park J, Jang W, Kim J Front Oncol. 2024; 14:1368926.

PMID: 38544836 PMC: 10965631. DOI: 10.3389/fonc.2024.1368926.

Ayoub H, Zamzam M, Elsemary E, Hassanin I, Elsayed F BMC Cancer. 2023; 23(1):927.

PMID: 37784085 PMC: 10544568. DOI: 10.1186/s12885-023-11448-3.

References

Temple L, Hsieh L, Wong W, Saltz L, Schrag D . Use of surgery among elderly patients with stage IV colorectal cancer. J Clin Oncol. 2004; 22(17):3475-84. DOI: 10.1200/JCO.2004.10.218. View

Coen J, Zietman A, Thakral H, Shipley W . Radical radiation for localized prostate cancer: local persistence of disease results in a late wave of metastases. J Clin Oncol. 2002; 20(15):3199-205. DOI: 10.1200/JCO.2002.01.086. View

Tannock I, de Wit R, Berry W, Horti J, Pluzanska A, Chi K . Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004; 351(15):1502-12. DOI: 10.1056/NEJMoa040720. View

Glass T, Tangen C, Crawford E, Thompson I . Metastatic carcinoma of the prostate: identifying prognostic groups using recursive partitioning. J Urol. 2002; 169(1):164-9. DOI: 10.1016/S0022-5347(05)64059-1. View

Suzman D, Antonarakis E . Castration-resistant prostate cancer: latest evidence and therapeutic implications. Ther Adv Med Oncol. 2014; 6(4):167-79. PMC: 4107711. DOI: 10.1177/1758834014529176. View

Nguyen D, Truong P, Alexander C, Walter C, Hayashi E, Christie J . Can locoregional treatment of the primary tumor improve outcomes for women with stage IV breast cancer at diagnosis?. Int J Radiat Oncol Biol Phys. 2012; 84(1):39-45. DOI: 10.1016/j.ijrobp.2011.11.046. View

Mohler J, Armstrong A, Bahnson R, Boston B, Busby J, DAmico A . Prostate cancer, Version 3.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2012; 10(9):1081-7. DOI: 10.6004/jnccn.2012.0114. View

Zelefsky M, Levin E, Hunt M, Yamada Y, Shippy A, Jackson A . Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008; 70(4):1124-9. DOI: 10.1016/j.ijrobp.2007.11.044. View

Demaria S, Ng B, Devitt M, Babb J, Kawashima N, Liebes L . Ionizing radiation inhibition of distant untreated tumors (abscopal effect) is immune mediated. Int J Radiat Oncol Biol Phys. 2004; 58(3):862-70. DOI: 10.1016/j.ijrobp.2003.09.012. View

10.

Kaplan R, Riba R, Zacharoulis S, Bramley A, Vincent L, Costa C . VEGFR1-positive haematopoietic bone marrow progenitors initiate the pre-metastatic niche. Nature. 2005; 438(7069):820-7. PMC: 2945882. DOI: 10.1038/nature04186. View

11.

Postow M, Callahan M, Barker C, Yamada Y, Yuan J, Kitano S . Immunologic correlates of the abscopal effect in a patient with melanoma. N Engl J Med. 2012; 366(10):925-31. PMC: 3345206. DOI: 10.1056/NEJMoa1112824. View

12.

Mickisch G, Garin A, van Poppel H, de Prijck L, Sylvester R . Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet. 2001; 358(9286):966-70. DOI: 10.1016/s0140-6736(01)06103-7. View

13.

Rapiti E, Verkooijen H, Vlastos G, Fioretta G, Neyroud-Caspar I, Sappino A . Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol. 2006; 24(18):2743-9. DOI: 10.1200/JCO.2005.04.2226. View

14.

Zelefsky M, Fuks Z, Hunt M, Yamada Y, Marion C, Ling C . High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys. 2002; 53(5):1111-6. DOI: 10.1016/s0360-3016(02)02857-2. View

15.

Hodi F, ODay S, Mcdermott D, Weber R, Sosman J, Haanen J . Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010; 363(8):711-23. PMC: 3549297. DOI: 10.1056/NEJMoa1003466. View

16.

Flanigan R, Salmon S, Blumenstein B, Bearman S, Roy V, McGrath P . Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2002; 345(23):1655-9. DOI: 10.1056/NEJMoa003013. View

17.

Nguyen D, Truong P, Walter C, Hayashi E, Christie J, Alexander C . Limited M1 disease: a significant prognostic factor for stage IV breast cancer. Ann Surg Oncol. 2012; 19(9):3028-34. DOI: 10.1245/s10434-012-2333-3. View

18.

Adli M, Sevinc A, Kalender M . Re: Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2006; 98(5):364-5. DOI: 10.1093/jnci/djj077. View

19.

Lee I, Seong J, Lee C, Kim Y, Keum K, Suh C . Early clinical experience and outcome of helical tomotherapy for multiple metastatic lesions. Int J Radiat Oncol Biol Phys. 2008; 73(5):1517-24. DOI: 10.1016/j.ijrobp.2008.07.035. View

20.

de Bono J, Logothetis C, Molina A, Fizazi K, North S, Chu L . Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med. 2011; 364(21):1995-2005. PMC: 3471149. DOI: 10.1056/NEJMoa1014618. View