Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：M1a疾病代表局部区域复发和骨转移疾病之间的中间状态。转移定向治疗（MDT），通过立体定向身体RT（SBRT）可以提供给患者，旨在专门治疗宏观复发部位，避免广泛的预防性治疗量。这似乎是一种可行的治疗方法，特别是在PSMA量身定制的治疗方法兴起之后。
方法：从前瞻性收集的数据集中检索在两个不同机构接受治疗的患者的数据。所有纳入的患者在根治性前列腺切除术或根治性前列腺切除术后均受寡复发性M1a疾病的影响，定义为位于主动脉分叉上方和肾动脉下方的≤3个结节病变。包括去势抵抗PCa（CRPC）和去势敏感（CSPC）PCa患者。所有成像方法均允许检测复发（CT扫描，胆碱或PSMAPET/CT）。所有复发部位均用SBRT治疗。
结果：中位PFS为10个月（95%CI8-17）。12名患者死亡,中位OS为114个月（95%CI85-114）。在83次复发中，2（2.4%），11（13.25%），36例（43.37%）和15例（18%）患者分别只有前列腺床，盆腔淋巴结,主动脉旁或远处复发。此外，19例（22.9%）患者在重新分期时经历了仅生化复发，影像学阴性。
结论：MDT在患有m1a疾病的CSPC和CRPC患者的混合队列中赋予了显着的PFS结局，具有最佳的安全性。为了比较这些患者的MDT和ENRT，需要进行前瞻性试验。允许选择最佳治疗方案。
方法：从前瞻性收集的数据集中检索在两个不同机构接受治疗的患者的数据。所有纳入的患者在根治性前列腺切除术或根治性前列腺切除术后均受寡复发性M1a疾病的影响，定义为位于主动脉分叉上方和肾动脉下方的≤3个结节病变。包括去势抵抗PCa（CRPC）和去势敏感（CSPC）PCa患者。所有成像方法均允许检测复发（CT扫描，胆碱或PSMAPET/CT）。所有复发部位均用SBRT治疗。
结果：中位PFS为10个月（95%CI8-17）。12名患者死亡,中位OS为114个月（95%CI85-114）。在83次复发中，2（2.4%），11（13.25%），36例（43.37%）和15例（18%）患者分别只有前列腺床，盆腔淋巴结,主动脉旁或远处复发。此外，19例（22.9%）患者在重新分期时经历了仅生化复发，影像学阴性。
结论：MDT在患有m1a疾病的CSPC和CRPC患者的混合队列中赋予了显着的PFS结局，具有最佳的安全性。为了比较这些患者的MDT和ENRT，需要进行前瞻性试验。允许选择最佳治疗方案。
