Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy

Elise De Bleser; Barbara Alicja Jereczek-Fossa; David Pasquier; Thomas Zilli; Nicholas Van As; Shankar Siva; Andrei Fodor; Piet Dirix; Alfonso Gomez-Iturriaga; Fabio Trippa; Beatrice Detti; Gianluca Ingrosso; Luca Triggiani; Alessio Bruni; Filippo Alongi; Dries Reynders; Gert De Meerleer; Alessia Surgo; Kaoutar Loukili; Raymond Miralbell; Pedro Silva; Sarat Chander; Nadia Gisella Di Muzio; Ernesto Maranzano; Giulio Francolini; Andrea Lancia; Alison Tree; Chiara Lucrezia Deantoni; Elisabetta Ponti; Giulia Marvaso; Els Goetghebeur; Piet Ost

doi:10.1016/j.eururo.2019.07.009

Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy

Elise De Bleser, Barbara Alicja Jereczek-Fossa, David Pasquier, Thomas Zilli, Nicholas Van As, Shankar Siva, Andrei Fodor, Piet Dirix, Alfonso Gomez-Iturriaga, Fabio Trippa, Beatrice Detti, Gianluca Ingrosso, Luca Triggiani, Alessio Bruni, Filippo Alongi, Dries Reynders, Gert De Meerleer, Alessia Surgo, Kaoutar Loukili, Raymond MiralbellPedro Silva, Sarat Chander, Nadia Gisella Di Muzio, Ernesto Maranzano, Giulio Francolini, Andrea Lancia, Alison Tree, Chiara Lucrezia Deantoni, Elisabetta Ponti, Giulia Marvaso, Els Goetghebeur, Piet Ost

Research output: Contribution to journal › Article

Abstract

BACKGROUND: Stereotactic body radiotherapy (SBRT) and elective nodal radiotherapy (ENRT) are being investigated as metastasis-directed treatments in oligorecurrent prostate cancer (PC); however, comparative data are still lacking. OBJECTIVE: To compare outcome and toxicity between both treatments. Primary endpoint was metastasis-free survival, adjusted for selected variables (aMFS). DESIGN, SETTING, AND PARTICIPANTS: This was a multi-institutional, retrospective analysis of 506 (SBRT: 309, ENRT: 197) patients with hormone-sensitive nodal oligorecurrent PC (five or fewer lymph nodes (LNs; N1/M1a), treated between 2004 and 2017. Median follow-up was 36 mo (interquartile range 23-56). INTERVENTION: SBRT was defined as a minimum of 5 Gy per fraction to each lesion with a maximum of 10 fractions. ENRT was defined as a minimum dose of 45 Gy in up to 25 fractions to the elective nodes, with or without a simultaneous boost to the suspicious node(s). The choice of radiotherapy (RT) was at the discretion of the treating physician, with treatments being unbalanced over the centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: In total, 506 patients from 15 different treatment centers were included. Primary treatment was radical prostatectomy, RT, or their combination. Nodal recurrences were detected by positron emission tomography/computer tomography (97%) or conventional imaging (3%). Descriptive statistics was used to summarize patient characteristics. RESULTS AND LIMITATIONS: ENRT was associated with fewer nodal recurrences compared with SBRT (p 

Original language	English
Pages (from-to)	732-739
Number of pages	8
Journal	European Urology
Volume	76
Issue number	6
DOIs	https://doi.org/10.1016/j.eururo.2019.07.009
Publication status	Published - Dec 2019

Keywords

Elective nodal radiotherapy
Metastasis-directed therapy
Oligometastasis
Oligorecurrence
Prostatic neoplasms
Radiotherapy
Recurrence
Stereotactic ablative body radiotherapy
Stereotactic body radiotherapy

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De Bleser, E., Jereczek-Fossa, B. A., Pasquier, D., Zilli, T., Van As, N., Siva, S., Fodor, A., Dirix, P., Gomez-Iturriaga, A., Trippa, F., Detti, B., Ingrosso, G., Triggiani, L., Bruni, A., Alongi, F., Reynders, D., De Meerleer, G., Surgo, A., Loukili, K., ... Ost, P. (2019). Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy. European Urology, 76(6), 732-739. https://doi.org/10.1016/j.eururo.2019.07.009

Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy. / De Bleser, Elise; Jereczek-Fossa, Barbara Alicja; Pasquier, David; Zilli, Thomas; Van As, Nicholas; Siva, Shankar; Fodor, Andrei; Dirix, Piet; Gomez-Iturriaga, Alfonso; Trippa, Fabio; Detti, Beatrice; Ingrosso, Gianluca; Triggiani, Luca; Bruni, Alessio; Alongi, Filippo; Reynders, Dries; De Meerleer, Gert; Surgo, Alessia; Loukili, Kaoutar; Miralbell, Raymond; Silva, Pedro; Chander, Sarat; Di Muzio, Nadia Gisella; Maranzano, Ernesto; Francolini, Giulio; Lancia, Andrea; Tree, Alison; Deantoni, Chiara Lucrezia; Ponti, Elisabetta; Marvaso, Giulia; Goetghebeur, Els; Ost, Piet.

In: European Urology, Vol. 76, No. 6, 12.2019, p. 732-739.

Research output: Contribution to journal › Article

De Bleser, E, Jereczek-Fossa, BA, Pasquier, D, Zilli, T, Van As, N, Siva, S, Fodor, A, Dirix, P, Gomez-Iturriaga, A, Trippa, F, Detti, B, Ingrosso, G, Triggiani, L, Bruni, A, Alongi, F, Reynders, D, De Meerleer, G, Surgo, A, Loukili, K, Miralbell, R, Silva, P, Chander, S, Di Muzio, NG, Maranzano, E, Francolini, G, Lancia, A, Tree, A, Deantoni, CL, Ponti, E, Marvaso, G, Goetghebeur, E & Ost, P 2019, 'Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy', European Urology, vol. 76, no. 6, pp. 732-739. https://doi.org/10.1016/j.eururo.2019.07.009

De Bleser E, Jereczek-Fossa BA, Pasquier D, Zilli T, Van As N, Siva S et al. Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy. European Urology. 2019 Dec;76(6):732-739. https://doi.org/10.1016/j.eururo.2019.07.009

De Bleser, Elise ; Jereczek-Fossa, Barbara Alicja ; Pasquier, David ; Zilli, Thomas ; Van As, Nicholas ; Siva, Shankar ; Fodor, Andrei ; Dirix, Piet ; Gomez-Iturriaga, Alfonso ; Trippa, Fabio ; Detti, Beatrice ; Ingrosso, Gianluca ; Triggiani, Luca ; Bruni, Alessio ; Alongi, Filippo ; Reynders, Dries ; De Meerleer, Gert ; Surgo, Alessia ; Loukili, Kaoutar ; Miralbell, Raymond ; Silva, Pedro ; Chander, Sarat ; Di Muzio, Nadia Gisella ; Maranzano, Ernesto ; Francolini, Giulio ; Lancia, Andrea ; Tree, Alison ; Deantoni, Chiara Lucrezia ; Ponti, Elisabetta ; Marvaso, Giulia ; Goetghebeur, Els ; Ost, Piet. / Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy. In: European Urology. 2019 ; Vol. 76, No. 6. pp. 732-739.

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title = "Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy",

abstract = "BACKGROUND: Stereotactic body radiotherapy (SBRT) and elective nodal radiotherapy (ENRT) are being investigated as metastasis-directed treatments in oligorecurrent prostate cancer (PC); however, comparative data are still lacking. OBJECTIVE: To compare outcome and toxicity between both treatments. Primary endpoint was metastasis-free survival, adjusted for selected variables (aMFS). DESIGN, SETTING, AND PARTICIPANTS: This was a multi-institutional, retrospective analysis of 506 (SBRT: 309, ENRT: 197) patients with hormone-sensitive nodal oligorecurrent PC (five or fewer lymph nodes (LNs; N1/M1a), treated between 2004 and 2017. Median follow-up was 36 mo (interquartile range 23-56). INTERVENTION: SBRT was defined as a minimum of 5 Gy per fraction to each lesion with a maximum of 10 fractions. ENRT was defined as a minimum dose of 45 Gy in up to 25 fractions to the elective nodes, with or without a simultaneous boost to the suspicious node(s). The choice of radiotherapy (RT) was at the discretion of the treating physician, with treatments being unbalanced over the centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: In total, 506 patients from 15 different treatment centers were included. Primary treatment was radical prostatectomy, RT, or their combination. Nodal recurrences were detected by positron emission tomography/computer tomography (97%) or conventional imaging (3%). Descriptive statistics was used to summarize patient characteristics. RESULTS AND LIMITATIONS: ENRT was associated with fewer nodal recurrences compared with SBRT (p ",

keywords = "Elective nodal radiotherapy, Metastasis-directed therapy, Oligometastasis, Oligorecurrence, Prostatic neoplasms, Radiotherapy, Recurrence, Stereotactic ablative body radiotherapy, Stereotactic body radiotherapy",

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T1 - Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy

AU - De Bleser, Elise

AU - Jereczek-Fossa, Barbara Alicja

AU - Pasquier, David

AU - Zilli, Thomas

AU - Van As, Nicholas

AU - Siva, Shankar

AU - Fodor, Andrei

AU - Dirix, Piet

AU - Gomez-Iturriaga, Alfonso

AU - Trippa, Fabio

AU - Detti, Beatrice

AU - Ingrosso, Gianluca

AU - Triggiani, Luca

AU - Bruni, Alessio

AU - Alongi, Filippo

AU - Reynders, Dries

AU - De Meerleer, Gert

AU - Surgo, Alessia

AU - Loukili, Kaoutar

AU - Miralbell, Raymond

AU - Silva, Pedro

AU - Chander, Sarat

AU - Di Muzio, Nadia Gisella

AU - Maranzano, Ernesto

AU - Francolini, Giulio

AU - Lancia, Andrea

AU - Tree, Alison

AU - Deantoni, Chiara Lucrezia

AU - Ponti, Elisabetta

AU - Marvaso, Giulia

AU - Goetghebeur, Els

AU - Ost, Piet

PY - 2019/12

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N2 - BACKGROUND: Stereotactic body radiotherapy (SBRT) and elective nodal radiotherapy (ENRT) are being investigated as metastasis-directed treatments in oligorecurrent prostate cancer (PC); however, comparative data are still lacking. OBJECTIVE: To compare outcome and toxicity between both treatments. Primary endpoint was metastasis-free survival, adjusted for selected variables (aMFS). DESIGN, SETTING, AND PARTICIPANTS: This was a multi-institutional, retrospective analysis of 506 (SBRT: 309, ENRT: 197) patients with hormone-sensitive nodal oligorecurrent PC (five or fewer lymph nodes (LNs; N1/M1a), treated between 2004 and 2017. Median follow-up was 36 mo (interquartile range 23-56). INTERVENTION: SBRT was defined as a minimum of 5 Gy per fraction to each lesion with a maximum of 10 fractions. ENRT was defined as a minimum dose of 45 Gy in up to 25 fractions to the elective nodes, with or without a simultaneous boost to the suspicious node(s). The choice of radiotherapy (RT) was at the discretion of the treating physician, with treatments being unbalanced over the centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: In total, 506 patients from 15 different treatment centers were included. Primary treatment was radical prostatectomy, RT, or their combination. Nodal recurrences were detected by positron emission tomography/computer tomography (97%) or conventional imaging (3%). Descriptive statistics was used to summarize patient characteristics. RESULTS AND LIMITATIONS: ENRT was associated with fewer nodal recurrences compared with SBRT (p 

AB - BACKGROUND: Stereotactic body radiotherapy (SBRT) and elective nodal radiotherapy (ENRT) are being investigated as metastasis-directed treatments in oligorecurrent prostate cancer (PC); however, comparative data are still lacking. OBJECTIVE: To compare outcome and toxicity between both treatments. Primary endpoint was metastasis-free survival, adjusted for selected variables (aMFS). DESIGN, SETTING, AND PARTICIPANTS: This was a multi-institutional, retrospective analysis of 506 (SBRT: 309, ENRT: 197) patients with hormone-sensitive nodal oligorecurrent PC (five or fewer lymph nodes (LNs; N1/M1a), treated between 2004 and 2017. Median follow-up was 36 mo (interquartile range 23-56). INTERVENTION: SBRT was defined as a minimum of 5 Gy per fraction to each lesion with a maximum of 10 fractions. ENRT was defined as a minimum dose of 45 Gy in up to 25 fractions to the elective nodes, with or without a simultaneous boost to the suspicious node(s). The choice of radiotherapy (RT) was at the discretion of the treating physician, with treatments being unbalanced over the centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: In total, 506 patients from 15 different treatment centers were included. Primary treatment was radical prostatectomy, RT, or their combination. Nodal recurrences were detected by positron emission tomography/computer tomography (97%) or conventional imaging (3%). Descriptive statistics was used to summarize patient characteristics. RESULTS AND LIMITATIONS: ENRT was associated with fewer nodal recurrences compared with SBRT (p 

KW - Elective nodal radiotherapy

KW - Metastasis-directed therapy

KW - Oligometastasis

KW - Oligorecurrence

KW - Prostatic neoplasms

KW - Radiotherapy

KW - Recurrence

KW - Stereotactic ablative body radiotherapy

KW - Stereotactic body radiotherapy

U2 - 10.1016/j.eururo.2019.07.009

DO - 10.1016/j.eururo.2019.07.009

M3 - Article

VL - 76

SP - 732

EP - 739

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 6

ER -