SBRT nella malattia oligoricorrente da carcinoma prostatico: studio retrospettivo multiistituzionale
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1 SBRT nella malattia oligoricorrente da carcinoma prostatico: studio retrospettivo multiistituzionale L. Triggiani(1), P. Ghirardelli(1), A. Bruni(2), F. Alongi(3), A. Magli(4), A. Bonetta(5), B. Detti (6), G.Ingrosso(7), F.Trippa(8), P. Borghetti(1), R. D Angelillo (9) M. Buglione(1), R. Santoni(7), L. Livi(6), S.M. Magrini(1) (1)Istituto del Radio, Spedali Civili Brescia, Brescia (2)U.O. Radioterapia Oncologica, AOU Policlinico di Modena, Modena (3)S.C. Radioterapia Oncologica, Ospedale Sacro Cuore Don Calabria, Negrar (Vr) (4)S.O.C. di Radioterapia Oncologica, Ospedale Santa Maria della Misericordia, Udine (5)U.O. Radioterapia, Ospedale di Cremona, Cremona (6)SODc Radioterapia Oncologica, DAI Oncologia, A.O.U Careggi, Firenze (7)U.O.C. di Radioterapia, Policlinico Tor Vergata, Roma (8)U.O. Radioterapia, Ospedale Santa Maria Terni, Terni (9)Campus Biomedico, Roma
2 Why SBRT for oligorecurrent PC? Local cura9ve Intent Low side effect Delay ADT/systemic therapies (second line) Local control Systemic control?
3 Pa9ents & Methods ff 141 pts (March January2016) 100 pts Oligorecurrent HSPC 41 pts Oligoprogressive CRPC BPFS ADT free survival DPFS Second Line Free survival
4 Pa9ents & Methods ff 141 pts (March January2016) 100 pts Oligorecurrent HSPC 41 pts Oligoprogressive CRPC BPFS ADT free survival DPFS Second Line Free survival
5 Pa9ents & Methods ff 141 pts (March January2016) 100 pts (139 lesions) Oligorecurrent HSPC 41 pts Oligoprogressive CRPC BPFS ADT free survival DPFS Second Line Free survival
6 Characteristic Oligorecurrent HSPC: D Amico Risks : - Low risk - Intermediate risk - High risk - Very high Gleason Score: - < 7-7 Primary Treatment: - Surgery - Surgery+EBRT - EBRT/Brachitherapy ADT Adjuvant -Yes -No characteris9cs (1) All patient (n=100)
7 Oligorecurrent HSPC: Characteristic characteris9cs (2) All patient (n=100) Median Age (years) 67 Median Time to MTS (month) (from primary treatment) 43,9 Median PSA pre-sbrt (ng/ml) 2,38 Restaging -PET Choline -TC/ Scintigraphy Site (%): -Node -Bone ADT with SBRT -Yes (median 11 ms, mean 10 ms) -No ,2 15,
8 Oligorecurrent HSPC: SBRT characteris9cs Characteristic Prophylactic Node irradiation - Yes - No All patient (n=100) 7 93 Median BED (α/ß= 3 Gy) 116
9 Oligorecurrent HSPC: Results (1) BPFS Median Follow-up= 20,4 months Survival (%) BPFS (median) 15,2 ms 1 yr 58,1% 2yrs 38,3% 3yrs 17,9% 15 pts second SBRT Months
10 Oligorecurrent HSPC: Results (2) ADT-FS Median Follow-up= 20,4 months Survival (%) ADT-FS (median) 20,93 ms 1 yr 67,4% 2yrs 47,3% 3yrs 31,0% Months
11 Oligorecurrent HSPC: Results (3): univariate analysis Prognos'c factors: - D Amico Risks - Gleason Score - Primary site of mts - n of mts - Interval from primary treatment - Pre- SBRT PSA value - Adjuvant ADT - BED - Prophylac'c nodal irradia'on - PSA dt NS SIGNIFICANT
12 Oligorecurrent HSPC: Results (4): univariate analysis PSA DT (Ms) BPFS p ADT-FS p < 6.4 Med (ms) -1 yr - 2 yrs - 3 yrs % 18,3% 0, % 21,4% 0,04 > 6.4 Med (ms) - 1 yr - 2 yrs - 3 yrs % 41.5% 19.3% 25,23 71,5% 51,2% 33,5%
13 Pa9ents & Methods ff 141 pts (March January2016) 100 pts Oligorecurrent HSPC 41 pts Oligoprogressive CRPC BPFS ADT free survival DPFS Second Line Free survival
14 Pa9ents & Methods ff 141 pts (March January2016) 100 pts Oligorecurrent HSPC 41 pts Oligoprogressive CRPC BPFS ADT free survival DPFS Second Line Free survival
15 Pa9ents & Methods ff 141 pts (March January2016) 100 pts Oligorecurrent HSPC 41 pts (70 lesions) Oligoprogressive CRPC BPFS ADT free survival DPFS Second Line Free survival
16 Oligoprogressive mcrpc : characteris9cs (1) ALL PTS (41) D Amico Risks : - Low risk - Intermediate risk - High risk - Very high Gleason Score: - < 7-7 Primary Treatment: - Surgery - Surgery+EBRT - EBRT/Brachitherapy - ADT
17 Oligoprogressive mcrpc : Characteristic characteris9cs (2) All patient (n=41) Median Age (years) 65 Time to castrate resistant (month) (from the start of palliative ADT) Median PSA pre-sbrt (ng/ ml) Restaging -PET Choline -TC/ Scintigrafy Site (%): -Node -Bone BED (Gy): 116
18 Oligoprogressive mcrpc: Results (1) DPFS Median Follow-up= 23,43 months Survival (%) DPFS (median) 11 ms 1 yr 43,2% 2yrs 21,6% 3yrs 13,9% 10 pts second SBRT Months
19 Oligoprogressive mcrpc: Results (2) Second-line-FS Median Follow-up= 23,43 months Survival (%) 2 nd line-fs (median) 22 ms 1 yr 74,8% 2yrs 41,3% 3yrs 29,5% Months
20 Oligorecurrent HSPC: Results (3): univariate analysis Prognos'c factors: - D Amico Risks - Gleason Score - Primary site of mts - n of mts NS - Time to castrate resistant - Pre- SBRT PSA value - BED
21 Conclusions SBRT is a safe and feasible treatment SBRT in oligorecurrent and oligoprogressive prostate cancer delay systemic therapies for about two years without toxicity Low PSA- DT is correlated with a worse ADT- FS Our results are similar to those present in literature Future Development: Prospec9ve trials are needed Role of concomitant ADT? Role of prophylac9c nodal RT? Combina9on with new hormonal therapy (Abiraterone, Enzalutamide)?
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