Targeting oligometastasis with stereotactic ablative radiation therapy or surgery in metastatic hormone-sensitive prostate cancer: a systematic review of prospective clinical trials
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Context: Metastasis directed therapy (MDT) in the form of stereotactic ablative radiation therapy (SABR), or in combination with surgical metastasectomy, may have a role in cancer control and disease progression.
Objective: To perform a systematic review of MDT (Surgery or SABR) for oligometastatic (up to 10 metastasis, recurrent or de novo) hormone-sensitive prostate cancer in addition or following primary prostate gland treatment.
Evidence Acquisition: Medline, Embase, Cochrane Review Database and Clinical Trial Databases were systematically searched for clinical trials reporting oncological outcomes and safety. Risk-of-bias was assessed with Cochrane 2.0 tool or ROBINS-I.
Evidence Synthesis: From 1,025 articles identified, 4 clinical trials met prespecified criteria. These included two randomised and two non-randomised clinical trials (n = 169). Baseline PSA-level, age and metastasis ranged from 2.0 – 17.0 ng/ml, 43 to 75 yrs and 1 to 7 lesions, respectively. Nodal, bone, nodal and bone, visceral metastases were present in 49.7% (84/169), 33.7% (57/169), 15.9% (27/169), and 0.5% (1/169), respectively. Diagnostic conventional imaging was used in 43.7% (74/169) and positron-emission-tomography/computerized tomography (PET/CT) in 56.2% (95/169). SABR and surgical metastasectomy with SABR was used in 78.3% (94/120), and 21.6% (26/120), respectively. Early progression-free survival (PFS) ranged from 19% to 60%. Local control (LC) was reported as 93% to 100%. Grade II and III SABR toxicity were reported in 8% (8/100) and 1% (1/100), respectively. Grade IIIa and IIIb surgical complications were reported in 7.69% (2/26) and 0% (0/26), respectively.
Conclusion: MDT is a promising experimental therapeutic approach in men with hormone sensitive oligometastatic prostate cancer. Randomized comparative studies are required to ascertain role and optimal timing in oligometastatic recurrence and efficacy in de novo synchronous disease.
Objective: To perform a systematic review of MDT (Surgery or SABR) for oligometastatic (up to 10 metastasis, recurrent or de novo) hormone-sensitive prostate cancer in addition or following primary prostate gland treatment.
Evidence Acquisition: Medline, Embase, Cochrane Review Database and Clinical Trial Databases were systematically searched for clinical trials reporting oncological outcomes and safety. Risk-of-bias was assessed with Cochrane 2.0 tool or ROBINS-I.
Evidence Synthesis: From 1,025 articles identified, 4 clinical trials met prespecified criteria. These included two randomised and two non-randomised clinical trials (n = 169). Baseline PSA-level, age and metastasis ranged from 2.0 – 17.0 ng/ml, 43 to 75 yrs and 1 to 7 lesions, respectively. Nodal, bone, nodal and bone, visceral metastases were present in 49.7% (84/169), 33.7% (57/169), 15.9% (27/169), and 0.5% (1/169), respectively. Diagnostic conventional imaging was used in 43.7% (74/169) and positron-emission-tomography/computerized tomography (PET/CT) in 56.2% (95/169). SABR and surgical metastasectomy with SABR was used in 78.3% (94/120), and 21.6% (26/120), respectively. Early progression-free survival (PFS) ranged from 19% to 60%. Local control (LC) was reported as 93% to 100%. Grade II and III SABR toxicity were reported in 8% (8/100) and 1% (1/100), respectively. Grade IIIa and IIIb surgical complications were reported in 7.69% (2/26) and 0% (0/26), respectively.
Conclusion: MDT is a promising experimental therapeutic approach in men with hormone sensitive oligometastatic prostate cancer. Randomized comparative studies are required to ascertain role and optimal timing in oligometastatic recurrence and efficacy in de novo synchronous disease.
Date Issued
2020-10
Date Acceptance
2020-07-09
Citation
European Urology Oncology, 2020, 3 (5), pp.582-593
ISSN
2588-9311
Publisher
Elsevier
Start Page
582
End Page
593
Journal / Book Title
European Urology Oncology
Volume
3
Issue
5
Copyright Statement
© 2020 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access articleunder the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Sponsor
Wellcome Trust
University College London Hospitals Charity
Imperial College Healthcare NHS Trust- BRC Funding
University College London Hospitals Charity
University College London Hospitals Charity
Identifier
https://www.sciencedirect.com/science/article/pii/S258893112030095X?via%3Dihub
Grant Number
204998/Z/16/Z
1348
RDB01
Charity Fund 1348
WSSY_P84790
Subjects
Ablative radiotherapy
Hormone sensitive
Metastasectomy
Metastasis-directed therapy
Oligometastatic
Oligorecurrent
Prostate cancer
Stereotactic ablative radiation therapy
Stereotactic body radiation therapy
Stereotactic radiotherapy
Publication Status
Published
Date Publish Online
2020-09-03