The onset of castration-resistance is associated with dismal outcomes in patients with prostate cancer (PCa). Metastasis directed therapy has been investigated in multiple disease settings and may improve outcomes in selected patients.
Our systematic review aims to summarize evidence with stereotactic body radiotherapy (SBRT) in castration-resistant prostate cancer (CRPC).
The literature search was performed on March 2024, on Pubmed, using the keywords "SBRT" AND "CRPC", and "stereotactic ablative radiotherapy (SABR)" AND "CRPC". This search retrieved a total of 108 articles, 19 were included.
The literature is largely dominated by retrospective series. In men with metachronous oligoprogression, SBRT with androgen receptor pathway inhibitor significantly increased progression-free survival (PFS) including biochemical progression-free survival in a randomized phase II trial (hazard ratio of 0.35, p < 0.001). In patients continuing ADT, the bPFS ranged between 9.5 months to 17.9 months, and next systemic treatment-free survival (NEST-FS) reached up to 2 years. In men with induced oligoprogression, SBRT enabled NEST-FS up to 3 years. SBRT was well tolerated, with less than 5% grade 3 toxicity reported across studies.
In the population of patients with oligometastatic CRPC, SBRT enables long-term biochemical response and PFS. In the oligoprogressive setting, SBRT could be integrated to prolong the duration and efficacy of systemic therapies. Nevertheless, the level of evidence remains very low and inclusion within prospective trials remain the preferred option for this population of patients.
Prostate cancer and prostatic diseases. 2024 Jun 19 [Epub ahead of print]
Jennifer Le Guevelou, Francesco Cuccia, Ronan Flippot, Giuseppe Ferrera, Mario Terlizzi, Thomas Zilli, Renaud De Crevoisier, Jean-Michel Hannoun-Levi, Stephane Supiot, Paul Sargos, David Pasquier
Department of Radiation Therapy, Centre Eugène Marquis, Rennes, France. ., Department of Radiation Therapy, ARNAS Civico Palermo, Palermo, Italy., Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France., Department of Radiation Therapy, Institut Gustave Roussy, Villejuif, France., Department of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland., Department of Radiation Therapy, Centre Eugène Marquis, Rennes, France., Department of Radiation Oncology, Centre Antoine Lacassagne, University Côte d'Azur, Nice, France., Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, France., Department of Radiation Oncology, Institut Bergonié, Bordeaux, France., Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/38898265