Background:To assess the efficacy of metastasis-directed external beam radiotherapy(MDT)in patients with castration-resistant prostate cancer(CRPC),we conducted a multicenter retrospective study.Materials and methods:...Background:To assess the efficacy of metastasis-directed external beam radiotherapy(MDT)in patients with castration-resistant prostate cancer(CRPC),we conducted a multicenter retrospective study.Materials and methods:We retrospectively analyzed data from patients with metastatic CRPC treated with MDT between January 2013 and July 2023 across 14 hospitals.Patients who received palliative or local radiation therapy or had insufficient clinical data were ex-cluded.The primary endpoint was the change in prostate-specific antigen(PSA)levels from pre-to post-MDT.Secondary endpoints included overall survival,time to next systemic therapy,PSA progression-free survival,and reduction of target lesions assessed radiographically.Results:Among 579 patients with metastatic prostate cancer who received radiation therapy,48 underwent MDT.The median follow-up period was 325 days,and the median patient age was 74 years.Metastasis-directed external beam radiotherapy target sites in-cluded bone(n=34,70.8%),lymph nodes(n=11,22.9%),local recurrence(n=2,4.2%),and other sites(n=1,2.1%).Of the 48 pa-tients,30(62.5%)showed a decrease in PSA levels after MDT,and 20(41.6%)achieved a PSA reduction greater than 50%.Among the 26 patients who underwent post-MDT radiographic evaluation,11(42.3%)demonstrated a reduction in target lesions.Median overall survival,PSA progression-free survival,and time to next systemic therapy for patients with and without a PSA response were 1307 ver-sus 614 days(p=0.038,log-rank test),233 versus 98 days(p=0.014,log-rank test),and 434 versus 450 days(p=0.273,log-rank test),respectively.The median PSA doubling time was 4.1 months in PSA responders and 1.7 months in nonresponders.Conclusions:Metastasis-directed external beam radiotherapy resulted in PSA reduction in 62.5%of patients with metastatic CRPC.Metastasis-directed external beam radiotherapy may be a suitable treatment option for patients with a favorable prognosis but may not benefit those with a poor prognosis and short PSA doubling time.展开更多
Metastatic breast cancer has been historically considered as an incurable disease.Radiotherapy(RT)has been traditionally used for only palliation of the symptoms caused by metastatic lesions.However,in recent years th...Metastatic breast cancer has been historically considered as an incurable disease.Radiotherapy(RT)has been traditionally used for only palliation of the symptoms caused by metastatic lesions.However,in recent years the concept of oligometastatic disease has been introduced in Cancer Medicine as a clinical scenario with a limited number of metastases(≤5)and involved organs(≤2)with controlled primary tumor.The main hypothesis in oligometastatic disease is that locoregional treatment of primary tumor site and metastasis-directed therapies with surgery and/or RT may improve outcomes.Recent studies have shown that not all metastatic breast cancer patients have the same prognosis,and selected patients with good prognostic features as those younger than 55 years,hormone receptor-positive,limited bone or liver metastases,a low-grade tumor,good performance status,long disease-free interval(>12 mo),and good response to systemic therapy may provide maximum benefit from definitive treatment procedures to all disease sites.While retrospective and prospective studies on locoregional treatment in oligometastatic breast cancer demonstrated conflicting results,there is an increasing trend in favor of locoregional treatment.Currently,available data also demonstrated the improvements in survival with metastasisdirected therapy in oligometastatic breast cancer.The current review will discuss the concept of oligometastases and provide up-to-date information about the role of RT in oligometastatic breast cancer.展开更多
Technological advances in radiotherapy have led to the introduction of techniques such as stereotactic body radiation therapy(SBRT), allowing the administration of ablative doses. The hypothesis that oligometastatic d...Technological advances in radiotherapy have led to the introduction of techniques such as stereotactic body radiation therapy(SBRT), allowing the administration of ablative doses. The hypothesis that oligometastatic disease may be cured through local eradication therapies has led to the increasing use of SBRT in patients with this type of disease. At the same time, scientific advances are being made to allow the confirmation of clinically suspected oligometastatic status at molecular level. There is growing interest in identifying patients with oligometastatic prostate cancer(PCa) who may benefit from curative intent metastasis-directed therapy, including SBRT. The aim is to complement, replace or delay the introduction of hormone therapy or other systemic therapies. The present review aims to compile the evidence from the main ongoing studies and results on SBRT in relation to oligometastatic PCa; examine aspects where gaps in knowledge or a lack of consensus persist(e.g., optimum schemes, response assessment, identification and diagnosis of oligometastatic patients); and document the lack of first-level evidence supporting the use of such techniques.展开更多
Two cases of penile metastasis from primary prostate cancer in a single center are presented,along with a literature review and description of the excision technique.Despite its rich vascularization,penile metastasis ...Two cases of penile metastasis from primary prostate cancer in a single center are presented,along with a literature review and description of the excision technique.Despite its rich vascularization,penile metastasis is rare,with 72 new cases from September 2006 to March 2021.There is a wide variety of diagnoses,treatments,and prognoses for penile metastatic lesions.Ga-68 prostatespecific membrane antigen positron emission tomography/computed tomography is the most sensitive imaging tool for detecting metastasis from primary prostate cancer.Magnetic resonance imaging of the penis is the most reliable technique for differentiating penile lesions.Histological diagnosis is mostly performed using fine-needle biopsy aspiration.Metastasis-directed treatment is not considered to contribute to prolonged survival.Local treatment is feasible and can be offered to symptomatic patients.Owing to a heterogeneous group,defining overall survival is difficult.Survival until 46months after detecting penile metastases is described.展开更多
文摘Background:To assess the efficacy of metastasis-directed external beam radiotherapy(MDT)in patients with castration-resistant prostate cancer(CRPC),we conducted a multicenter retrospective study.Materials and methods:We retrospectively analyzed data from patients with metastatic CRPC treated with MDT between January 2013 and July 2023 across 14 hospitals.Patients who received palliative or local radiation therapy or had insufficient clinical data were ex-cluded.The primary endpoint was the change in prostate-specific antigen(PSA)levels from pre-to post-MDT.Secondary endpoints included overall survival,time to next systemic therapy,PSA progression-free survival,and reduction of target lesions assessed radiographically.Results:Among 579 patients with metastatic prostate cancer who received radiation therapy,48 underwent MDT.The median follow-up period was 325 days,and the median patient age was 74 years.Metastasis-directed external beam radiotherapy target sites in-cluded bone(n=34,70.8%),lymph nodes(n=11,22.9%),local recurrence(n=2,4.2%),and other sites(n=1,2.1%).Of the 48 pa-tients,30(62.5%)showed a decrease in PSA levels after MDT,and 20(41.6%)achieved a PSA reduction greater than 50%.Among the 26 patients who underwent post-MDT radiographic evaluation,11(42.3%)demonstrated a reduction in target lesions.Median overall survival,PSA progression-free survival,and time to next systemic therapy for patients with and without a PSA response were 1307 ver-sus 614 days(p=0.038,log-rank test),233 versus 98 days(p=0.014,log-rank test),and 434 versus 450 days(p=0.273,log-rank test),respectively.The median PSA doubling time was 4.1 months in PSA responders and 1.7 months in nonresponders.Conclusions:Metastasis-directed external beam radiotherapy resulted in PSA reduction in 62.5%of patients with metastatic CRPC.Metastasis-directed external beam radiotherapy may be a suitable treatment option for patients with a favorable prognosis but may not benefit those with a poor prognosis and short PSA doubling time.
文摘Metastatic breast cancer has been historically considered as an incurable disease.Radiotherapy(RT)has been traditionally used for only palliation of the symptoms caused by metastatic lesions.However,in recent years the concept of oligometastatic disease has been introduced in Cancer Medicine as a clinical scenario with a limited number of metastases(≤5)and involved organs(≤2)with controlled primary tumor.The main hypothesis in oligometastatic disease is that locoregional treatment of primary tumor site and metastasis-directed therapies with surgery and/or RT may improve outcomes.Recent studies have shown that not all metastatic breast cancer patients have the same prognosis,and selected patients with good prognostic features as those younger than 55 years,hormone receptor-positive,limited bone or liver metastases,a low-grade tumor,good performance status,long disease-free interval(>12 mo),and good response to systemic therapy may provide maximum benefit from definitive treatment procedures to all disease sites.While retrospective and prospective studies on locoregional treatment in oligometastatic breast cancer demonstrated conflicting results,there is an increasing trend in favor of locoregional treatment.Currently,available data also demonstrated the improvements in survival with metastasisdirected therapy in oligometastatic breast cancer.The current review will discuss the concept of oligometastases and provide up-to-date information about the role of RT in oligometastatic breast cancer.
文摘Technological advances in radiotherapy have led to the introduction of techniques such as stereotactic body radiation therapy(SBRT), allowing the administration of ablative doses. The hypothesis that oligometastatic disease may be cured through local eradication therapies has led to the increasing use of SBRT in patients with this type of disease. At the same time, scientific advances are being made to allow the confirmation of clinically suspected oligometastatic status at molecular level. There is growing interest in identifying patients with oligometastatic prostate cancer(PCa) who may benefit from curative intent metastasis-directed therapy, including SBRT. The aim is to complement, replace or delay the introduction of hormone therapy or other systemic therapies. The present review aims to compile the evidence from the main ongoing studies and results on SBRT in relation to oligometastatic PCa; examine aspects where gaps in knowledge or a lack of consensus persist(e.g., optimum schemes, response assessment, identification and diagnosis of oligometastatic patients); and document the lack of first-level evidence supporting the use of such techniques.
文摘Two cases of penile metastasis from primary prostate cancer in a single center are presented,along with a literature review and description of the excision technique.Despite its rich vascularization,penile metastasis is rare,with 72 new cases from September 2006 to March 2021.There is a wide variety of diagnoses,treatments,and prognoses for penile metastatic lesions.Ga-68 prostatespecific membrane antigen positron emission tomography/computed tomography is the most sensitive imaging tool for detecting metastasis from primary prostate cancer.Magnetic resonance imaging of the penis is the most reliable technique for differentiating penile lesions.Histological diagnosis is mostly performed using fine-needle biopsy aspiration.Metastasis-directed treatment is not considered to contribute to prolonged survival.Local treatment is feasible and can be offered to symptomatic patients.Owing to a heterogeneous group,defining overall survival is difficult.Survival until 46months after detecting penile metastases is described.
