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ESTRO 36 2017
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local, 1 in the mediastinal lymph nodes, 3 combined
lymph-nodal (2 mediastinal, 1 para aortic) and
bone/visceral metastases, and 7 distant metastases
(bone, visceral) only. Twenty-four pts have deceased,
but only 3 due to prostate cancer. Five and 7 year
actuarial biochemical relapse-free survival (bRFS) was
87% and 80%, respectively(Fig I); corresponding rates of
disease-free survival (DFS, accounting for both local and
distant failures) were 90% and 84% (Fig. II), of distant
metastases -free survival (DMFS) 91% and 89%. overall
survival (OS) 89% and 78%, and of cancer specific survival
(CSS) 98% and 96%, respectively.
Grading/Toxicit
y
Acute
GU
Acute
rectal
Acute
bowel
Late
GU
Late GI
G0
29
(25.2%
)
74
(64.4%
)
63
(54.9%
)
57
(49.6%
)
82
(71.3%
)
G1
54
(47.0%
)
35
(30.4%
)
42
(36.5%
)
37
(32.2%
)
17
(14.8%
)
G2
31
(27.0%
)
6
(5.2%)
9
(7.8%)
15
(13.0%
)
12
(10.4%
)
G3
1
(0.8%) 0
1
(0.8%)
6
(5.2%)
4
(3.5%)
Conclusion
HR PCa pts treated with a combination of PLN irradiation,
high dose to the prostate delivered with image-guided
intensity-modulated moderately hypofractionated RT,
(EQD2 for a/b=3 roughly 88Gy), showed excellent 5 and 7
year BRFS and CSS. The main cause of biochemical relapse
was regional and/or systemic, mostly outside the pelvis,
likely due to pre-existent micro-metastatic disease. While
such disease cannot be prevented even by the most
extreme dose-escalation, our results suggest that its
impact appear to be significantly limited by prophylactic
PLN irradiation.
EP-1319 “Adjuvant”/ radical radiotherapy in prostate
cancer patients with synchronous bone oligometastasis
C.L. Deantoni
1
, A. Fodor
1
, C. Sini
2
, B. Noris Chiorda
1
, C.
Cozzarini
1
, C. Fiorino
2
, I. Dell'Oca
1
, M. Picchio
3
, E.
Incerti
3
, P. Mangili
2
, R. Calandrino
2
, L. Gianolli
3
, N. Di
Muzio
1
1
San Raffaele Scientific Institute, Radiotherapy, Milano,
Italy
2
San Raffaele Scientific Institute, Medical Physics,
Milano, Italy
3
San Raffaele Scientific Institute, Nuclear Medicine,
Milano, Italy
Purpose or Objective
To report the clinical results, obtained in a
monoinstitutional experience, in prostate cancer (PCa) pts
with synchronous oligometastatic bone disease treated
with radical surgery followed by adjuvant radiotherapy
with radical intent.
Material and Methods
From May 2009 to December 2015, 18 oligometastatic (for
the purpose of this analysis, no more than 2 bone
metastases)
PCa
pts
underwent
radical
prostatectomy+pelvic/lombo-aortic (LA) lymph-node
dissection. After surgery, all pts were simoultaneously
treated to bone metastasis (2Gy equivalent dose, EQD2
>40 Gy, α/β=2.2), as well as “adjuvant” RT to the pelvic
± LA nodes (median EQD2 52.2 Gy) and to the seminal
vescicle and prostatic bed (median EQD2 60 and 72.4 Gy,
respectively, α/β=1.5), in association with androgen
deprivation therapy (ADT). Nine pts were treated with
conventional fractionation, while 9 with hypofractionated
schedule (2,35 Gy/fr in 5 pts or 2,55 Gy/fr in 4 pts).
Patients’ characteristics are reported in Table I.
Median ( range) age at diagnosis 58.6 (50.5-76.4) years
Median (range) iPSA
11.44
(2.40-149.00)
ng/ml
Median ( range) Gleason Score 9 (7-10)
T Stage
pT2:
1
pT3a:
7
pT3b:
9
pT4: 1
N Stage
pN0:
4
pN1: 14
Bone metastasis number
1:
14
2: 4
Median (range) PSA before RT 0.19 (0.00-75.83) ng/ml
Median ( range) follow up after
RT
26.3 (4.8-79.4) months
Results
After a median follow up of 26.3 (4.8-79.4) months, only
one patient have deceased owing to prostate cancer
progression, while 17 are still alive. Seven pts experienced
a relapse, whose characteristics are as follows: 2
biochemical only, 1 in the irradiation field and 4 out of
field. At the last follow up, 12 pts were under ADT, of
whom one in combination with chemotherapy, while 5
ended ADT and were free from relapse, after a median of
28 (range: 13.3-35) months. Acute toxicity was very mild,
with no Grade >2 events, and only 2 serious late events, 1
G3 and 1 G4 urinary (salvage cystectomy for gross
haematuria) toxicity, in a patient treated with
hypofractionation (2,55 Gy/fr). With respect to bone, no
Grade≥1 toxicity were reported. The median biochemical
relapse-free survival (bRFS) was 45.3 months. Actuarial 3-
and 5-year bRFS was 73% and 37%, respectively, while the
distant progression-free survival (DPFS) was 80% and 64%,
respectively
(Fig
Ia
and
b)