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Pattern of recurrence after stereotactic body radiotherapy for para-aortic oligo-recurrent prostate cancer, a multicentric analysis

  • Radiotherapy
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Abstract

Background

M1a disease represents an intermediate status between loco-regional relapse and bone metastatic disease. Metastasis directed therapy (MDT), through stereotactic body RT (SBRT) may be offered to patients, aiming to exclusively treat sites of macroscopic relapse and avoiding wide prophylactic treatment volumes. This appears as a viable treatment, especially after the rise of PSMA tailored treatment approaches.

Materials and methods

Data about patients treated in two different institutions were retrieved from a prospectively collected dataset. All included patients were affected by oligo-recurrent M1a disease after definitive RT or radical prostatectomy, defined as ≤ 3 nodal lesions situated above aortic bifurcation and below renal arteries. Both castration resistant PCa (CRPC) and castration sensitive (CSPC) PCa patients were included. All imaging methods were allowed to detect recurrence (CT scan, Choline or PSMA PET/CT).All sites of recurrences were treated with SBRT.

Results

Median PFS was 10 months (95% CI 8–17). Twelve patients died, with a median OS of 114 months (95% CI 85–114). Out of the 83 recurrences, 2 (2.4%), 11 (13.25%), 36 (43.37%) and 15 (18%) patients had respectively prostate bed only, pelvic nodal, para-aortic or distant relapse. Furthermore, 19 (22.9%) patients experienced a biochemical only relapse with negative imaging at re-staging.

Discussion

MDT conferred a remarkable PFS outcome in a mixed cohort of CSPC and CRPC patients with m1a disease, with an optimal safety profile. Prospective trials are needed in order to compare MDT and ENRT for these patients, allowing to select the best treatment option.

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Acknowledgements

We hereby would like to thank Fondazione Radioterapia Oncologica (FRO) and all those that have provided a key support to scientific researches. We would also like to thank all the companies that through their unconditional and spontaneous donation contributed to the actual implementation of scientific research and to our studies. More specifically we would like to deeply thank Conad, Fondazione Cassa di Risparmio di Pistoia e Pescia, Fabiani, Rinascente, Giorgio Tesi Group, IFCA, Permira.

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Authors and Affiliations

  1. Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Giulio Francolini, Vanessa Di Cataldo, Beatrice Detti, Mauro Loi, Gabriele Simontacchi & Daniela Greto

  2. Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy

    Pietro Garlatti, Victoria Lorenzetti, Michele Ganovelli, Luisa Caprara, Carolina Orsatti, Luca Burchini, Giulio Frosini, Niccolò Bertini, Isacco Desideri, Icro Meattini & Lorenzo Livi

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

    Luca Triggiani & Vittorio Morelli

  4. Radiotherapy Unit, Azienda Ospedaliera Universitaria, 43126, Parma, Italy

    Nicola Simoni & Federico Colombo

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  1. Giulio Francolini
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Correspondence to Giulio Francolini.

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Ethical approval was waived by the local Ethics Committees. The study was performed according to the Declaration of Helsinki, and written informed consent was obtained for all patients.

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All patients gave consent for the use of their anonymized data for research and educational purposes. All procedures were performed in accordance with ethical standards of institutional ethical committee.

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Francolini, G., Garlatti, P., Di Cataldo, V. et al. Pattern of recurrence after stereotactic body radiotherapy for para-aortic oligo-recurrent prostate cancer, a multicentric analysis. Radiol med 128, 1423–1428 (2023). https://doi.org/10.1007/s11547-023-01701-x

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