Long-Term Outcomes of Patients on a Phase II Prospective Trial of Oligometastatic Hormone-Sensitive Prostate Cancer Treated with Androgen Deprivation and External Beam Radiation
Mené entre 2006 et 2011 sur 29 patients atteints d'un cancer de la prostate oligométastatique hormono-sensible (âge médian : 66,9 ans ; durée médiane de suivi : 9,9 ans), cet essai de phase II évalue l'efficacité, du point de vue de la survie globale et de la survie sans progression, d'un traitement associant des antagonistes des androgènes et une radiothérapie externe
Résumé en anglais
Purpose: External beam radiation therapy (EBRT) to oligometastases may improve outcomes in patients with oligometastatic hormone-sensitive prostate cancer (oHSPC). Follow-up on this cohort has been limited to <5 years and prospective data on de novo oHSPC patients is lacking. We reviewed the long-term outcomes of oHSPC patients treated with EBRT and androgen deprivation therapy (ADT) on a prospective trial.
Materials and Methods: From 2006 to 2011, oHSPC patients with 1-5 metastases (mts) received 36 weeks of ADT (LHRH agonist + bicalutamide) and up to 53 Gy to all visible mts. When indicated, the primary tumor or prostate bed was treated with EBRT up to 78 Gy or 66 Gy, respectively.
Results: 29 patients were treated: 15 de novo, 14 oligorecurrent. 21 patients (72.4%) had bone mts. Median number of mts per patient was 1 (range 1-5). EBRT was administered to 52 lesions (38 bone, 12 pelvic lymph nodes [LNs], 2 non-pelvic LNs) up to 53 Gy (range 47-66). Median follow-up was 9.9 years (yrs, range 0.2-14.4). Median overall survival (OS) was 9.7 yrs (95% Confidence Interval [CI]:5.8-Not Reached [NR]). Median progression-free survival (PFS) was 1.9 yrs (95%CI: 1.6-2.2). Patients who presented with prostate cancer-defined de novo mts had significantly improved (p=0.04) median PFS (2.0 yrs, 95%CI: 1.3-6.0) compared to oligorecurrent pts (1.8 yrs, 95%CI: 1.0-2.0). Patients who presented with LN-only mts had numerically improved (p=0.13) median PFS (5.8 yrs, 95%CI: 1.2-NR) compared to patients with bony mts (1.8 yrs, 95%CI: 1.3-2.0). At last follow-up, 17 patients (58.6%) had local control of all EBRT treated mts. The mts that locally progressed had previously been controlled for median 3.5 yrs (range 1.7-10.5).
Conclusion: Our results compare favorably with other reported studies of oHSPC and provide new insights into their long-term outcomes.
