Triple.

Top Line: What is the best treatment approach for oligometastatic prostate cancer?

The Study: Oligometastatic cancer is an exciting topic in radiation oncology these days. And a particularly exciting sub-topic is oligometastatic prostate cancer. On the one hand, the STAMPEDE data suggests an improvement in survival with prostate-directed radiation (not so much to the sites of metastasis). On the other hand, non-prostate oligometastatic data would suggest a benefit to treating all known disease aggressively. Not to mention data from smaller trials showing a benefit to metastasis-directed therapy for prostate cancer. Which should we do? Here we have the Johns Hopkins experience with an approach directing aggressive treatment to all sites of disease for over 150 patients between 2013 and 2018. Over three-quarters were treated for hormone-sensitive oligo-recurrent disease, meaning they had received prior definitive prostate treatment. The remaining de novo metastatic patients appeared to receive both prostate-directed and metastasis-directed radiation. Most of them had 5 or fewer sites of disease and received largely SBRT-like treatment. In fact, nearly half had just a single metastatic site. The most common sites were bone (54%) and nodes (43%). Less than 10% experienced local progression and the median biochemical progression free survival time was over one year. Interestingly, patients with nodal disease were more likely to fail in a node while those with bone disease were more likely to fail in the bone.

TBL: Aggressive metastasis-directed radiation for oligometastatic prostate cancer appears to have favorable disease control and fairly low toxicity. | Deek, Int J Radiat Oncol Biol Phys 2019