When should SBRT be offered to oligometastatic bone disease in a patient with prostate cancer?

Recently a multi-institutional analysis set standards for use in prospective assessment of SBRT for use in men with > 1 bone metastasis and up to 3 (data shown below). The Rx was well tolerated and local control was significantly improved if a BED > 100 Gy was utilized.

At this time this approach remains investigational and should only be done on study. One arm of the STAMPEDE study includes Rx of the primary and metastatic lesions and will address whether Rx of mets + primary disease is superior to ADT alone.

I hope this is helpful,

Anthony

Eur Urol. 2015 Jul 16. pii: S0302-2838(15)00608-9. doi: 10.1016/j.eururo.2015.07.004. [Epub ahead of print]

Progression-free Survival Following Stereotactic Body Radiotherapy for Oligometastatic Prostate C...

SBRT for prostate cancer in the asymptomatic setting in order to improve survival or progression-free survival should be considered an unproven but potentially useful approach. Note that NRG Oncology-RTOG is testing SBRT prospectively.

Trial BR001 is a phase I trial assessing the safety of SBRT for 2-4 metastatic lesions and prostate cancer cases were eligible. However, the main trial assessing efficacy, BR002, was activated in Dec 2014 and randomizes breast cancer patients with 1-2 oligo mets to systemic therapy +/- SBRT to all lesions. If BR001 shows that 3 or 4 lesions can be safely treated, then BR002 will open to patients with 1-4 lesions. Primary endpoint is PFS. Should this study be "positive", it would validate SBRT for oligo mets ...