Stereotactic ablative radiation therapy for oligometastatic prostate cancer delays time-to-next systemic treatment

C. Leigh Moyer, Ryan Phillips, Matthew P. Deek, Noura Radwan, Ashley E. Ross, Emmanuel Antonarakis, Diane Reyes, Jean Wright, Stephanie A Terezakis, Danny Y Song, Curtiland Deville, Patrick Walsh, Theodore DeWeese, Michael A Carducci, Edward M. Schaeffer, Kenneth Pienta, Mario Eisenberger, Phuoc T Tran

Research output: Contribution to journalArticle

Abstract

Purpose: Local ablative treatment to oligometastatic patients can result in long-term disease-free survival in some cancer patients. The importance of this treatment paradigm in prostate cancer is a rapidly evolving field. Herein, we report on the safety and preliminary clinical outcomes of a modern cohort of oligometastatic prostate cancer (OPC) patients treated with consolidative stereotactic ablative radiation (SABR). Methods: Records of men with OPC who underwent consolidative SABR at our institution were reviewed. SABR was delivered in 1–5 fractions of 5–18 Gray. Kaplan–Meier estimates of local progression-free survival (LPFS), biochemical progression-free survival (bPFS; PSA nadir + 2), distant progression-free survival (DPFS), and time-to-next intervention (TTNI) were calculated. Results: In total, 66 OPC patients were identified with consolidative SABR delivered to 134 metastases: 89 bone, 40 nodal, and 5 viscera. The majority of men (49/66) had hormone-sensitive prostate cancer (HSPC). Crude grade 1 and 2 acute toxicities were 36% and 11%, respectively, with no ≥ grade 3 toxicity. At 1 year, LPFS was 92% and bPFS and DPFS were 69%. Of the 18 men with HSPC who had deferred hormone therapy , 11 (56%) remain disease free following SABR (1-year ADT-FS was 78%). In 17 castration-resistant men, 11 had > 50% prostate-specific antigen (PSA) declines with 1-year TTNI of 30%. Conclusions: Consolidative SABR in OPC is feasible and well tolerated. The heterogeneity and small size of our series limit extrapolation of clinically meaningful outcomes following consolidative SABR in OPC, but our preliminary data suggest that this approach warrants continued prospective study.

Original languageEnglish (US)
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Jan 1 2018

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Prostatic Neoplasms
Radiotherapy
Disease-Free Survival
Radiation
Hormones
Therapeutics
Prostate-Specific Antigen
Viscera
Castration
Prospective Studies
Neoplasm Metastasis
Safety
Bone and Bones
Neoplasms

Keywords

  • Androgen-deprivation therapy
  • Oligometastatic prostate cancer
  • Stereotactic ablative radiation therapy

ASJC Scopus subject areas

  • Urology

Cite this

Stereotactic ablative radiation therapy for oligometastatic prostate cancer delays time-to-next systemic treatment. / Moyer, C. Leigh; Phillips, Ryan; Deek, Matthew P.; Radwan, Noura; Ross, Ashley E.; Antonarakis, Emmanuel; Reyes, Diane; Wright, Jean; Terezakis, Stephanie A; Song, Danny Y; Deville, Curtiland; Walsh, Patrick; DeWeese, Theodore; Carducci, Michael A; Schaeffer, Edward M.; Pienta, Kenneth; Eisenberger, Mario; Tran, Phuoc T.

In: World Journal of Urology, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Purpose: Local ablative treatment to oligometastatic patients can result in long-term disease-free survival in some cancer patients. The importance of this treatment paradigm in prostate cancer is a rapidly evolving field. Herein, we report on the safety and preliminary clinical outcomes of a modern cohort of oligometastatic prostate cancer (OPC) patients treated with consolidative stereotactic ablative radiation (SABR). Methods: Records of men with OPC who underwent consolidative SABR at our institution were reviewed. SABR was delivered in 1–5 fractions of 5–18 Gray. Kaplan–Meier estimates of local progression-free survival (LPFS), biochemical progression-free survival (bPFS; PSA nadir + 2), distant progression-free survival (DPFS), and time-to-next intervention (TTNI) were calculated. Results: In total, 66 OPC patients were identified with consolidative SABR delivered to 134 metastases: 89 bone, 40 nodal, and 5 viscera. The majority of men (49/66) had hormone-sensitive prostate cancer (HSPC). Crude grade 1 and 2 acute toxicities were 36{\%} and 11{\%}, respectively, with no ≥ grade 3 toxicity. At 1 year, LPFS was 92{\%} and bPFS and DPFS were 69{\%}. Of the 18 men with HSPC who had deferred hormone therapy , 11 (56{\%}) remain disease free following SABR (1-year ADT-FS was 78{\%}). In 17 castration-resistant men, 11 had > 50{\%} prostate-specific antigen (PSA) declines with 1-year TTNI of 30{\%}. Conclusions: Consolidative SABR in OPC is feasible and well tolerated. The heterogeneity and small size of our series limit extrapolation of clinically meaningful outcomes following consolidative SABR in OPC, but our preliminary data suggest that this approach warrants continued prospective study.",
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author = "Moyer, {C. Leigh} and Ryan Phillips and Deek, {Matthew P.} and Noura Radwan and Ross, {Ashley E.} and Emmanuel Antonarakis and Diane Reyes and Jean Wright and Terezakis, {Stephanie A} and Song, {Danny Y} and Curtiland Deville and Patrick Walsh and Theodore DeWeese and Carducci, {Michael A} and Schaeffer, {Edward M.} and Kenneth Pienta and Mario Eisenberger and Tran, {Phuoc T}",
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T1 - Stereotactic ablative radiation therapy for oligometastatic prostate cancer delays time-to-next systemic treatment

AU - Moyer, C. Leigh

AU - Phillips, Ryan

AU - Deek, Matthew P.

AU - Radwan, Noura

AU - Ross, Ashley E.

AU - Antonarakis, Emmanuel

AU - Reyes, Diane

AU - Wright, Jean

AU - Terezakis, Stephanie A

AU - Song, Danny Y

AU - Deville, Curtiland

AU - Walsh, Patrick

AU - DeWeese, Theodore

AU - Carducci, Michael A

AU - Schaeffer, Edward M.

AU - Pienta, Kenneth

AU - Eisenberger, Mario

AU - Tran, Phuoc T

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Y1 - 2018/1/1

N2 - Purpose: Local ablative treatment to oligometastatic patients can result in long-term disease-free survival in some cancer patients. The importance of this treatment paradigm in prostate cancer is a rapidly evolving field. Herein, we report on the safety and preliminary clinical outcomes of a modern cohort of oligometastatic prostate cancer (OPC) patients treated with consolidative stereotactic ablative radiation (SABR). Methods: Records of men with OPC who underwent consolidative SABR at our institution were reviewed. SABR was delivered in 1–5 fractions of 5–18 Gray. Kaplan–Meier estimates of local progression-free survival (LPFS), biochemical progression-free survival (bPFS; PSA nadir + 2), distant progression-free survival (DPFS), and time-to-next intervention (TTNI) were calculated. Results: In total, 66 OPC patients were identified with consolidative SABR delivered to 134 metastases: 89 bone, 40 nodal, and 5 viscera. The majority of men (49/66) had hormone-sensitive prostate cancer (HSPC). Crude grade 1 and 2 acute toxicities were 36% and 11%, respectively, with no ≥ grade 3 toxicity. At 1 year, LPFS was 92% and bPFS and DPFS were 69%. Of the 18 men with HSPC who had deferred hormone therapy , 11 (56%) remain disease free following SABR (1-year ADT-FS was 78%). In 17 castration-resistant men, 11 had > 50% prostate-specific antigen (PSA) declines with 1-year TTNI of 30%. Conclusions: Consolidative SABR in OPC is feasible and well tolerated. The heterogeneity and small size of our series limit extrapolation of clinically meaningful outcomes following consolidative SABR in OPC, but our preliminary data suggest that this approach warrants continued prospective study.

AB - Purpose: Local ablative treatment to oligometastatic patients can result in long-term disease-free survival in some cancer patients. The importance of this treatment paradigm in prostate cancer is a rapidly evolving field. Herein, we report on the safety and preliminary clinical outcomes of a modern cohort of oligometastatic prostate cancer (OPC) patients treated with consolidative stereotactic ablative radiation (SABR). Methods: Records of men with OPC who underwent consolidative SABR at our institution were reviewed. SABR was delivered in 1–5 fractions of 5–18 Gray. Kaplan–Meier estimates of local progression-free survival (LPFS), biochemical progression-free survival (bPFS; PSA nadir + 2), distant progression-free survival (DPFS), and time-to-next intervention (TTNI) were calculated. Results: In total, 66 OPC patients were identified with consolidative SABR delivered to 134 metastases: 89 bone, 40 nodal, and 5 viscera. The majority of men (49/66) had hormone-sensitive prostate cancer (HSPC). Crude grade 1 and 2 acute toxicities were 36% and 11%, respectively, with no ≥ grade 3 toxicity. At 1 year, LPFS was 92% and bPFS and DPFS were 69%. Of the 18 men with HSPC who had deferred hormone therapy , 11 (56%) remain disease free following SABR (1-year ADT-FS was 78%). In 17 castration-resistant men, 11 had > 50% prostate-specific antigen (PSA) declines with 1-year TTNI of 30%. Conclusions: Consolidative SABR in OPC is feasible and well tolerated. The heterogeneity and small size of our series limit extrapolation of clinically meaningful outcomes following consolidative SABR in OPC, but our preliminary data suggest that this approach warrants continued prospective study.

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