Five-year outcomes of fractionated stereotactic body radiotherapy for oligometastatic prostate cancer from the TRANSFORM phase II trial
- Author(s)
- See, AW; Conway, P; Frydenberg, M; Haxhimolla, H; Costello, AJ; Moon, D; Ruljancich, P; Grummet, J; Pranavan, G; Peters, J; Smyth, LML; Gwini, SM; McKenzie, DP; Bowden, P;
- Details
- Publication Year 2024-10-01,Volume 155,Issue #7,Page 1248-1256
- Journal Title
- International Journal of Cancer
- Publication Type
- Research article
- Abstract
- Metastasis-directed therapy (MDT) for oligometastatic prostate cancer (PCa), including stereotactic body radiotherapy (SBRT), has shown promise but is still considered investigational. This is the 5-year analysis of the TRANSFORM trial, the largest prospective cohort of men with oligometastatic PCa treated with SBRT-based MDT. The primary endpoint was 5-year treatment escalation-free survival (TE-FS), defined as freedom from any new cancer therapy other than further SBRT. In total, 199 men received SBRT; 76.4% were hormone-naïve at baseline. The rate of 5-year TE-FS was 21.7% (95% confidence interval [CI]: 15.7%-28.7%) overall and 25.4% (95% CI: 18.1%-33.9%) in the hormone-naïve subgroup. The subgroups with International Society of Urological Pathology Grade Groups 4-5 disease (hazard ratio [HR] = 1.48, 95% CI: 1.05-2.01, p = .026), a higher baseline prostate-specific antigen (PSA) (HR = 1.06, 95% CI: 1.03-1.09, p < .001) and those who received prior androgen deprivation therapy (ADT) (HR = 2.13, 95% CI: 1.40-3.26, p < .001), were at greater risk of treatment escalation. Outcomes for participants with four or five initial lesions were comparable to those with one to three lesions. At last follow-up, 18.9% (95% CI: 13.2%-25.7%) of participants were free from treatment escalation (median follow-up of 67.9 months) and two participants had an undetectable PSA level. No treatment-related grade three or higher adverse events were reported. The findings of this study demonstrate that SBRT-based MDT is an effective option for delaying systemic treatment escalation in the context of oligometastatic PCa. Future randomised trials comparing SBRT-based MDT to standard-of-care ADT-based approaches are required to evaluate the impact of delaying ADT on survival.
- Publisher
- Wiley
- Keywords
- Humans; Male; *Prostatic Neoplasms/pathology/radiotherapy; *Radiosurgery/methods; Aged; Middle Aged; Prospective Studies; Neoplasm Metastasis; Aged, 80 and over; Treatment Outcome; Prostate-Specific Antigen/blood; Dose Fractionation, Radiation; androgen deprivation therapy; oligometastases; prostate cancer; stereotactic body radiotherapy
- Department(s)
- Surgical Oncology
- Publisher's Version
- https://doi.org/10.1002/ijc.35052
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-09-03 07:46:52
Last Modified: 2024-09-03 07:49:20