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Stereotactic radiosurgery for bone metastases in oligometastatic prostate cancer patients: DESTROY-2 clinical trial subanalysis

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A Correspondence to this article was published on 03 March 2022

Abstract

Introduction

Aim of this analysis was to report toxicity and clinical outcomes in oligorecurrent prostate cancer (PCa) patients treated with single fraction stereotactic radiosurgery (SRS) for bone metastases.

Methods

We separately analyzed clinical data of PCa patients with bone oligometastases enrolled in a prospective phase I trial (DESTROY-2). DESTROY-2 was based on SRS delivered using volumetric modulated arc therapy in patients with primary or metastatic tumors in several extra-cranial body sites. Acute and late toxicity, biochemical tumor response, local control (LC), distant metastases-free (DPFS), progression-free (PFS), time to next-line systemic treatment-free (NEST-FS), and overall survival (OS) were calculated.

Results

Data on 37 PCa patients, carrying out 50 bone metastases, candidates for curative-intent treatment and treated with SRS at our Institution were collected. SRS dose ranged between 12 and 24 Gy. One grade 1 acute skin toxicity in one patient treated on the hip (24 Gy) and one grade 1 late skin toxicity in a patient with a scapular lesion (24 Gy) were recorded. No cases of bone fracture were registered in the treated population. With a median follow-up of 25 months (range 3–72 months) 2-year actuarial LC, DPFS, PFS, and OS were 96.7%, 58.1%, 58.1%, and 95.8%, respectively. Median and 2-year NEST-FS were 30 months (range 1–69 months) and 51.2%, respectively.

Conclusions

Data analysis showed few toxicity events, high local control rate and prolonged NEST-FS after linear accelerator-based radiosurgery of bone oligometastases from PCa. The possibility of postponing systemic treatments in patients with oligometastatic PCa by means of SRS should be taken into account. Further prospective studies on larger series are needed to confirm the reported results.

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Data availability

Data will be made available on reasonable request.

Abbreviations

PCa:

Prostate cancer

PSMA-PET:

Prostate-specific membrane antigen positron emission tomography

SBRT:

Stereotactic body radiotherapy

SRS:

Stereotactic radiosurgery

LC:

Local control

VMAT:

Volumetric modulated Arc therapy

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PTV:

Planning target volume

ECOG-PS:

Eastern cooperative oncology group performance status

PSA:

Prostate serum antigen

NEST-FS:

Time to next-line systemic treatment-free survival

DPFS:

Distant progression-free survival

PFS:

Progression-free survival

OS:

Overall survival

VAS:

Pain visual analog scale

BED:

Biological equivalent dose

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Author notes

  1. A. G. Morganti and G. Macchia share the last authorship.

Authors and Affiliations

  1. Radiation Oncology Unit, Gemelli Molise S.P.A. Hospital, Università Cattolica del S. Cuore, Largo A. Gemelli 1, 86100, Campobasso, Italy

    F. Deodato, D. Pezzulla, M. Ferro, P. Bonome & G. Macchia

  2. Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy

    S. Cilla & C. Romano

  3. Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    M. Buwenge & A. G. Morganti

  4. Department of Experimental, Diagnostic, and Specialty Medicine–DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy

    M. Buwenge & A. G. Morganti

  5. Radiotherapy Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Giuseppe Massarenti, Bologna, Italy

    A. Zamagni

  6. Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    L. Strigari

  7. Radiology Institute, Università Cattolica del Sacro Cuore, 00135, Rome, Italy

    F. Deodato & V. Valentini

  8. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCCS, UOC di Radioterapia Oncologica, Rome, Italy

    V. Valentini

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  1. F. Deodato
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Corresponding author

Correspondence to D. Pezzulla.

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The trial was approved by the local Institutional Review Board (P#988/CE/2010).

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All the patients gave their informed consent prior to their inclusions in the study.

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Deodato, F., Pezzulla, D., Cilla, S. et al. Stereotactic radiosurgery for bone metastases in oligometastatic prostate cancer patients: DESTROY-2 clinical trial subanalysis. Clin Transl Oncol 24, 1177–1183 (2022). https://doi.org/10.1007/s12094-021-02764-w

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