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Radiotherapy at oligoprogression for metastatic castration-resistant prostate cancer patients: a multi-institutional analysis

  • Radiotherapy
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Abstract

Purpose

To retrospectively estimate the impact of radiotherapy as a progression-directed therapy (PDT) in oligoprogressive metastatic castration-resistant prostate cancer (mCRPC) patients under androgen receptor-target therapy (ARTT).

Materials and methods

mCRPC patients are treated with PDT. End-points were time to next-line systemic treatment (NEST), radiological progression-free survival (r-PFS) and overall survival (OS). Toxicity was registered according to Common Terminology Criteria for Adverse Events v4.0. Survival analysis was performed using the Kaplan–Meier method; univariate and multivariate analyses were performed.

Results

Fifty-seven patients were analyzed. The median follow-up after PDT was 25.2 months (interquartile, 17.1–44.5). One-year NEST-free survival, r-PFS and OS were 49.8%, 50.4% and 82.1%, respectively. At multivariate analysis, polymetastatic condition at diagnosis of metastatic hormone-sensitive prostate cancer (mHSPC) (HR 2.82, p = 0.004) and PSA doubling time at diagnosis of mCRPC (HR 2.76, p = 0.006) were associated with NEST-free survival. The same variables were associated with r-PFS (HR 2.32, p = 0.021; HR 2.24, p = 0.021). One patient developed late grade ≥ 2 toxicity.

Conclusion

Our study shows that radiotherapy in oligoprogressive mCRPC is safe, is effective and seems to prolong the efficacy of ARTT in patients who otherwise would have gone systemic treatment switch, positively affecting disease progression. Prospective trials are needed.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Radiotherapy Oncology Operative Unit, Department of Medicine and Surgery and Translational Medicine, St Andrea Hospital, “Sapienza” University of Rome, Rome, Italy

    Maurizio Valeriani & Luca Marinelli

  2. Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 1, 50134, Florence, Italy

    Beatrice Detti, Giulio Francolini & Lorenzo Livi

  3. Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy

    Andrei Fodor & Nadia Di Muzio

  4. Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Networking, Florence, Italy

    Saverio Caini

  5. Unit of Radiation Oncology, S. Donato Hospital, Arezzo, Italy

    Simona Borghesi

  6. Department of Radiation Oncology, ‘S. Maria’ Hospital, Terni, Italy

    Fabio Trippa

  7. Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy

    Luca Triggiani & Stefano Maria Magrini

  8. Radiotherapy Unit, University Hospital of Modena, Modena, Italy

    Alessio Bruni

  9. Radiotherapy Unit, Ospedale “Vito Fazzi”, Lecce, Italy

    Donatella Russo

  10. Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy

    Simonetta Saldi, Cynthia Aristei & Gianluca Ingrosso

  11. Radiotherapy Unit, “Nuovo San Salvatore” Hospital, L’Aquila, Italy

    Mario Di Staso

  12. Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Andrea Lancia

Authors
  1. Maurizio Valeriani
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  2. Beatrice Detti
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  3. Andrei Fodor
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  4. Saverio Caini
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  5. Simona Borghesi
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  6. Fabio Trippa
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  7. Luca Triggiani
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  8. Alessio Bruni
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  9. Donatella Russo
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  10. Simonetta Saldi
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  11. Mario Di Staso
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  12. Giulio Francolini
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  13. Andrea Lancia
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  14. Luca Marinelli
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  15. Nadia Di Muzio
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  16. Cynthia Aristei
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  17. Lorenzo Livi
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  18. Stefano Maria Magrini
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  19. Gianluca Ingrosso
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Contributions

Valeriani, Detti, Lancia, Ingrosso, Francolini performed study concept and design. All authors done acquisition of data. Caini, Detti, Ingrosso, Lancia were involved in analysis and interpretation of data. Ingrosso, Detti, Caini, Francolini, Lancia, Valeriani drafted the manuscript. All authors done critical revision of the manuscript for important intellectual content. Caini, Ingrosso, Detti, Valeriani done statistical analysis. Fodor, Magrini, Livi, Musio, Osti, Filippi, Maranzano, Di Muzio, Aristei supervised the study. All authors have made a substantial contribution to research design, or the acquisition, analysis or interpretation of data. All authors have drafted the paper and revised it critically and have approved the submitted final version.

Corresponding author

Correspondence to Beatrice Detti.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Ethical approval was waived by the local Ethics Committee of University of Perugia in view of the retrospective nature of the study and all the procedures being performed were part of routine care. The study was performed according to the Declaration of Helsinki, and written informed consent was obtained for all patients. Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

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Cite this article

Valeriani, M., Detti, B., Fodor, A. et al. Radiotherapy at oligoprogression for metastatic castration-resistant prostate cancer patients: a multi-institutional analysis. Radiol med 127, 108–116 (2022). https://doi.org/10.1007/s11547-021-01424-x

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  • DOI: https://doi.org/10.1007/s11547-021-01424-x

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