Efficacy of repeated PSMA PET-directed radiotherapy for oligorecurrent prostate cancer after initial curative therapy.
Strahlenther Onkol
; 196(11): 1006-1017, 2020 Nov.
Article
em En
| MEDLINE
| ID: mdl-32399639
ABSTRACT
PURPOSE:
To assess the outcome of prostate cancer (PCa) patients diagnosed with oligorecurrent disease and treated with a first and a second PSMA (prostate-specific membrane antigen ligand) PET(positron-emission tomography)-directed radiotherapy (RT). PATIENTS ANDMETHODS:
Thirty-two patients with oligorecurrent relapse after curative therapy received a first PSMA PET-directed RT of all metastases. After biochemical progression, all patients received a second PSMA PET-directed RT of all metastases. The main outcome parameters were biochemical progression-free survival (bPFS) and androgen deprivation therapy-free survival (ADT-FS). The intervals of BPFS were analyzed separately as follows the interval from the last day of PSMA PET-directed RT to the first biochemical progression was defined as bPFS_1 and the interval from second PSMA PET-directed RT to further biochemical progression was defined as bPFS_2.RESULTS:
The median follow-up duration was 39.5 months (18-60). One out of 32 (3.1%) patients died after 47 months of progressive metastatic prostate cancer (mPCa). All patients showed biochemical responses after the first PSMA PET-directed RT and the median prostate-specific antigen (PSA) level before RT was 1.70â¯ng/mL (0.2-3.8), which decreased significantly to a median PSA nadir level of 0.39â¯ng/mL (range <0.07-3.8; pâ¯= 0.004). The median PSA level at biochemical progression after the first PSMA PET-directed RT was 2.9â¯ng/mL (range 0.12-12.80; pâ¯= 0.24). Furthermore, the PSA level after the second PSMA PET-directed RT at the last follow-up (0.52â¯ng/mL, range <0.07-154.0) was not significantly different (pâ¯= 0.36) from the median PSA level (1.70â¯ng/mL, range 0.2-3.8) before the first PSMA PET-directed RT. The median bPFS_1 was 16.0 months after the first PSMA PET-directed RT (95% CI 11.9-19.2) and the median bPFS_2 was significantly shorter at 8.0 months (95% CI 6.3-17.7) after the second PSMA PET-directed RT (pâ¯= 0.03; 95% CI 1.9-8.3). Multivariate analysis revealed no significant parameter for bPFS_1, whereas extrapelvic disease was the only significant parameter (pâ¯= 0.02, OR 2.3; 95% CI 0.81-4.19) in multivariate analysis for bPFS_2. The median ADT-FS was 31.0 months (95% CI 20.1-41.8) and multivariate analysis showed that patients with bone metastases, compared to patients with only lymph node metastases at first PSMA PET-directed RT, had a significantly higher chance (pâ¯= 0.007, OR 4.51; 95% CI 1.8-13.47) of needing ADT at the last follow-up visit.CONCLUSION:
If patients are followed up closely, including PSMA PET scans, a second PSMA PET-directed RT represents a viable treatment option for well-informed and well-selected patients.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Próstata
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Adenocarcinoma
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Biomarcadores Tumorais
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Glutamato Carboxipeptidase II
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Tomografia por Emissão de Pósitrons
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Radioterapia Guiada por Imagem
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Antígenos de Neoplasias
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Antígenos de Superfície
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
Limite:
Aged
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article