68Ga-PSMA-PET/CT-based Radiosurgery and Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Oct 21

PMID 33085712

Citations 10

Authors

Goda Kalinauskaite

Carolin Senger

Anne Kluge

Christian Furth

Markus Kufeld

Ingeborg Tinhofer

Volker Budach

Marcus Beck

Alexandra Hochreiter

Arne Grun

Carmen Stromberger

Affiliations

Soon will be listed here.

Abstract

Background: Androgen deprivation therapy (ADT) remains the standard therapy for patients with oligometastatic prostate cancer (OMPC). Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT)-based stereotactic body radiotherapy (SBRT) is emerging as an alternative option to postpone starting ADT and its associated side effects including the development of drug resistance. The aim of this study was to determine progression free-survival (PFS) and treatment failure free-survival (TFFS) after PSMA-PET/CT-based SBRT in OMPC patients. The efficacy and safety of single fraction radiosurgery (SFRS) and ADT delay were investigated.

Methods: Patients with ≤5 metastases from OMPC, with/without ADT treated with PSMA-PET/CT-based SBRT were retrospectively analyzed. PFS and TFFS were primary endpoints. Secondary endpoints were local control (LC), overall survival (OS) and ADT-free survival (ADTFS).

Results: Fifty patients with a total of 75 metastases detected by PSMA-PET/CT were analyzed. At the time of SBRT, 70% of patients were castration-sensitive. Overall, 80% of metastases were treated with SFRS (median dose 20 Gy, range: 16-25). After median follow-up of 34 months (range: 5-70) median PFS and TFFS were 12 months (range: 2-63) and 14 months (range: 2-70), respectively. Thirty-two (64%) patients had repeat oligometastatic disease. Twenty-four (48%) patients with progression underwent second SBRT course. Two-year LC after SFRS was 96%. Grade 1 and 2 toxicity occurred in 3 (6%) and 1 (2%) patients, respectively. ADTFS and OS rates at 2-years were 60.5% and 100%, respectively. In multivariate analysis, TFFS significantly improved in patients with time to first metastasis (TTM) >36 months (p = 0.01) and PSA before SBRT ≤1 ng/ml (p = 0.03).

Conclusion: For patients with OMPC, SBRT might be used as an alternative to ADT. This way, the start/escalation of palliative ADT and its side effects can be deferred. Metastases treated with PSMA-PET/CT-based SFRS reached excellent LC with minimal toxicity. Low PSA levels and longer TTM predict elongated TFFS.

Citing Articles

Changing Role of PET/CT in Cancer Care With a Focus on Radiotherapy.

Vijayakumar S, Yang J, Nittala M, Velazquez A, Huddleston B, Rugnath N Cureus. 2023; 14(12):e32840.

PMID: 36694538 PMC: 9867792. DOI: 10.7759/cureus.32840.

Management of Patients with Recurrent and Metachronous Oligometastatic Prostate Cancer in the Era of PSMA PET.

Sabbagh A, Mohamad O, Lichter K, Hope T Cancers (Basel). 2022; 14(24).

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Current role of prostate-specific membrane antigen-based imaging and radioligand therapy in castration-resistant prostate cancer.

Chen J, Qi L, Tang Y, Tang G, Gan Y, Cai Y Front Cell Dev Biol. 2022; 10:958180.

PMID: 36036001 PMC: 9411749. DOI: 10.3389/fcell.2022.958180.

PSMA and Choline PET for the Assessment of Response to Therapy and Survival Outcomes in Prostate Cancer Patients: A Systematic Review from the Literature.

Alongi P, Laudicella R, Lanzafame H, Farolfi A, Mapelli P, Picchio M Cancers (Basel). 2022; 14(7).

PMID: 35406542 PMC: 8997431. DOI: 10.3390/cancers14071770.

Radiotherapy in oligometastatic prostate cancer-a pattern of care survey among members of the German Society for Radiation Oncology (DEGRO).

Rogowski P, Trapp C, von Bestenbostel R, Konnerth D, Marschner S, Schmidt Hegemann N Strahlenther Onkol. 2022; 198(8):727-734.

PMID: 35364690 PMC: 9300519. DOI: 10.1007/s00066-022-01925-2.

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