Vol 26, No 4 (2021)
Research paper
Published online: 2021-04-08

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Radiation therapy with curative intention in men with de novo metastatic prostate carcinoma: shoot ‘em all!

Angel Montero1, Ovidio Hernando1, Veronica Cañon1, Diana Guevara1, Jeannete Valero1, Xin Chen-Zhao1, Paz Garcia-Acilu2, Emilio Sanchez1, Mercedes Lopez1, Raquel Ciervide1 Ciervide1, Mariola Garcia-Aranda1, Beatriz Alvarez1, Alejandro Prado2, Rosa Alonso1, Pedro Fernandez-Leton2, Carmen Rubio1
DOI: 10.5603/RPOR.a2021.0077
Rep Pract Oncol Radiother 2021;26(4):605-615.

Abstract

BACKGROUND: About 5% of prostate cancer cases are metastatic at diagnoses. Radiotherapy of both primary tumor and secondary lesions can be, in addition to systemic treatments, a radical alternative for selected patients.

MATERIALS AND METHODS: Patients with de novo prostate carcinoma with bone or lymph node metastases were retrospectively reviewed. All patients received moderate hypofractionated IMRT/VMAT up to 63 Gy in 21 daily fractions of 3 Gy to prostate and metastases with neoadjuvant and concurrent androgen deprivation therapy (ADT). According to known advances some patients also received abiraterone, enzalutamide, or docetaxel.

RESULTS: Between 2015–2020, we attended 26 prostate cancer patients (median age 69.5 years, range 52–84) with simultaneous oligometastases [mean 2.1 metastases, median 1.5 metastases (range 1–6)]. Eighteen patients (69%) presented lymph node metastases, 4 (15.5%) bone metastases and 4 (15.5%) both lymph node and bone metastases. With a median follow-up of 15.5 months (range 3–65 months), 16 patients (62%) are alive and tumor free while 10 (38%) are alive with tumor. Four patients (17%) developed tumor progression, out of irradiated area in all cases, with a median time to progression of 43.5 months (range 27–56 months). Actuarial progression-free survival (PFS) rates at 12 and 24 months were 94.1% and 84.7%, respectively. No grade > 2 acute or late complications were recorded.

CONCLUSIONS: Simultaneous directed radical hypofractionated radiation therapy for prostate and metastases is feasible, well tolerated and achieves an acceptable PFS rate. However, further studies with longer follow-up are necessary to definitively address these observations.

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