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Would you add whole-pelvis radiation as MDT (metastasis-directed therapy) in a patient with 1 pelvic node and 2 osseous metastatic sites for castrate-resistant prostate cancer?
Patient had RP as initial treatment, GS 4+4, pT3 (ECE) pN0 (0 of 18), adjuvant 70.2 Gy to prostatic fossa, then developed BCR and eventually PSMA PET CT demonstrated oligometastatic (3 sites) disease while on ADT. Abiraterone was added. My plan was to offer SBRT to the 3 PET-positive sites, but the patient and family want to be aggressive, requesting the whole pelvis be treated as well. Does the recent PEACE V- STORM trial impact your decision?
Answer from: Radiation Oncologist at Academic Institution
This patient would not fit the PEACE V-Storm eligibility criteria, since the trial excluded patients with distant metastases and did not include patients who were castrate resistant, so I do not think you can extrapolate the results to this patient. One could argue that what you propose to do (SBRT ...
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Answer from: Radiation Oncologist at Academic Institution
I would offer SBRT to visible disease. In the setting of gross bone metastases, elective treatment for hypothetical microscopic disease has unclear value. The patient and family can be assured that SBRT to oligometastases is already aggressive (and is lacking phase III RCT evidence). This strategy a...
Answer from: Radiation Oncologist at Community Practice
Totally agree with the comments of Professors @Mitchell S. Anscher and @Tyler Seibert above!For what it's worth, the recently published continuous ADT part of the EXTEND trial included around 24% CRPC patients, and nearly 2/3 received ARPI as well. The PFS benefit on post-hoc multivariable analysis ...
Comments
Radiation Oncologist at UC San Diego
Great catch! I agree it doesn’t change the a...
Great catch! I agree it doesn’t change the a...
Radiation Oncologist at Hôtel Dieu de Lévis - CISSS Chaudière-Appalaches
Thank you! It is buried in the supplementary mater...
Thank you! It is buried in the supplementary mater...