经多中心分析显示，经立体定向体放射治疗对于腔隙性经腹主动脉的少数复发前列腺癌患者后的复发模式。
Pattern of recurrence after stereotactic body radiotherapy for para-aortic oligo-recurrent prostate cancer, a multicentric analysis.
发表日期：2023 Aug 19
作者：
Giulio Francolini, Pietro Garlatti, Vanessa Di Cataldo, Luca Triggiani, Nicola Simoni, Beatrice Detti, Victoria Lorenzetti, Federico Colombo, Vittorio Morelli, Michele Ganovelli, Luisa Caprara, Carolina Orsatti, Luca Burchini, Giulio Frosini, Niccolò Bertini, Mauro Loi, Gabriele Simontacchi, Daniela Greto, Isacco Desideri, Icro Meattini, Lorenzo Livi
来源：
Bone & Joint Journal
摘要：
M1a疾病是局部复发和骨转移病之间的中间状态。通过立体定向放射治疗（SBRT）的转移定向治疗（MDT）可以提供给患者，旨在仅治疗宏观复发部位，并避免广泛的预防性治疗范围。特别是在PSMA个体化治疗方法兴起之后，这似乎是一种可行的治疗方式。从一个前瞻性收集的数据集中检索了两个不同机构治疗的患者的数据。所有被纳入的患者在放射治疗或激素切除术后都患有寡发性M1a疾病，定义为腹主动脉分叉以上、肾动脉以下≤3个淋巴结病灶。包括了激素耐药型前列腺癌（CRPC）和激素敏感型（CSPC）前列腺癌患者。所有成像方法都被允许用于检测复发（CT扫描、胆碱或PSMA PET/CT）。所有复发部位都接受了SBRT治疗。中位无进展生存期（PFS）为10个月（95% CI 8-17）。12名患者死亡，中位总生存期（OS）为114个月（95% CI 85-114）。在83个复发中，分别有2例（2.4%）、11例（13.25%）、36例（43.37%）和15例（18%）患者仅有前列腺床、盆腔淋巴结、副腹主动脉或远处复发。此外，19例（22.9%）患者在再分期时经历了仅生化复发并且影像检查结果为阴性。MDT在CSPC和CRPC患者的m1a疾病混合队列中取得了显著的PFS效果，并且具有最佳的安全性。需要进行前瞻性试验以比较MDT和扩展野放射治疗（ENRT）对这些患者的疗效，以选择最佳的治疗方案。© 2023. Italian Society of Medical Radiology.
M1a disease represents an intermediate status between loco-regional relapse and bone metastatic disease. Metastasis directed therapy (MDT), through stereotactic body RT (SBRT) may be offered to patients, aiming to exclusively treat sites of macroscopic relapse and avoiding wide prophylactic treatment volumes. This appears as a viable treatment, especially after the rise of PSMA tailored treatment approaches.Data about patients treated in two different institutions were retrieved from a prospectively collected dataset. All included patients were affected by oligo-recurrent M1a disease after definitive RT or radical prostatectomy, defined as ≤ 3 nodal lesions situated above aortic bifurcation and below renal arteries. Both castration resistant PCa (CRPC) and castration sensitive (CSPC) PCa patients were included. All imaging methods were allowed to detect recurrence (CT scan, Choline or PSMA PET/CT).All sites of recurrences were treated with SBRT.Median PFS was 10 months (95% CI 8-17). Twelve patients died, with a median OS of 114 months (95% CI 85-114). Out of the 83 recurrences, 2 (2.4%), 11 (13.25%), 36 (43.37%) and 15 (18%) patients had respectively prostate bed only, pelvic nodal, para-aortic or distant relapse. Furthermore, 19 (22.9%) patients experienced a biochemical only relapse with negative imaging at re-staging.MDT conferred a remarkable PFS outcome in a mixed cohort of CSPC and CRPC patients with m1a disease, with an optimal safety profile. Prospective trials are needed in order to compare MDT and ENRT for these patients, allowing to select the best treatment option.© 2023. Italian Society of Medical Radiology.