SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS  WITH METASTATIC CASTRATION-RESISTANT PROSTATE  CANCER DEVELOPING OLIGO-PROGRESSION UNDER  ANTIANDROGEN TREATMENT

Göktaş Aydın, Sabin; Kutlu, Yasin; Muğlu, Harun; Açıkgöz, Özgür; Bilici, Ahmet; Ölmez, Ömer; Ünal, Dilek; Karcı, Ebru; Yıldız, Özcan

doi:https://dx.doi.org/10.26650/IUITFD.1211556

Research Article

DOI :10.26650/IUITFD.1211556 IUP :10.26650/IUITFD.1211556 Full Text (PDF)

SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT

Sabin Göktaş Aydın, Yasin Kutlu, Harun Muğlu, Özgür Açıkgöz, Ahmet Aydın, Ahmet Bilici, Ömer Fatih Ölmez, Dilek Ünal, Ebru Karcı, Özcan Yıldız

Objective: Androgen pathway inhibitors have a significant impact on the treatment of prostate cancer. The treatment approach is controversial in patients who develop oligo-progression under anti-androgen therapy. This study aimed to investigate the effects of metastasis-directed stereotactic body radiotherapy (SBRT) on survival in the first-line setting of patients with metastatic castration-resistant prostate cancer who continued the antiandrogen therapy after oligo-progression. Materials and Methods: Fifty-seven metastatic castration-resistant (serum testosterone <50 ng/dl) prostate cancer patients treated with abiraterone or enzalutamide in the first-line setting were analysed retrospectively. Thirty-nine of the patients with the oligo-progressive disease, which was defined as ≤3 lesions on imaging, received SBRT by continuing the same antiandrogen therapy. Results: The median age was 70 (range 40-85). In the castration-sensitive setting, 27 (47.4%) patients received docetaxel. The oligo-progressive metastatic sites were as follows: bone in 21 (52.3%), lymph node in 6 (15.3%) and visceral metastasis in 12 (30.9%) patients. Abiraterone and enzalutamide were preferred in 47.4% and 52.6% of patients, respectively. The 12-month progression-free survival (PFS) was 79.0% and 88.9% in patients who received or did not receive SBRT (p<0.001). SBRT-related grade 1-2 toxicity was observed in 35 (61.4%) patients. SBRT was also an independent risk factor for PFS (p=0.007, HR:15.7; 95% CI 2.05-118.7). The presence of visceral metastases, isolated bone metastases, the choice of anti-androgen therapy, and Eastern Cooperative Oncology Group Scale Performance Status (ECOG PS) were not significantly associated with PFS. SBRT had no impact on overall survival. Conclusion: Patients treated with metastasis-directed SBRT without changing treatment in the oligo-progression setting had worse survival outcomes. Thus, metastasis-directed SBRT with continuation of the same antiandrogen therapy should be prioritised only in selected cases.

Keywords: Stereotactic body radiotherapy, abiraterone, enzalutamide, castration-resistant prostate cancer

DOI :10.26650/IUITFD.1211556 IUP :10.26650/IUITFD.1211556 Full Text (PDF)

ANTİANDROJEN TEDAVİSİ ALTINDA OLİGO-PROGRESYON GELİŞEN METASTATİK KASTRASYONA DİRENÇLİ PROSTAT KANSERLİ HASTALARDA METASTAZA YÖNELİK VÜCUT RADYOTERAPİSİNİN SAĞKALIM ETKİSİ

Sabin Göktaş Aydın, Yasin Kutlu, Harun Muğlu, Özgür Açıkgöz, Ahmet Aydın, Ahmet Bilici, Ömer Fatih Ölmez, Dilek Ünal, Ebru Karcı, Özcan Yıldız

Amaç: Androjen yolağı inhibitörleri prostat kanserinin tedavisinde önemli etkiye sahiptir. Anti-androjen tedavisi altında oligo-progresyon gelişen hastalarda tedavi yaklaşımı tartışmalıdır. Bu çalışma, metastaza yönelik stereotaktik vücut radyoterapisinin (SBRT) oligo-ilerlemeden sonra antiandrojen tedavisine devam eden metastatik kastrasyona dirençli prostat kanserli hastalarda birinci basamakta sağkalım üzerindeki etkilerini araştırmayı amaçladı. Gereç ve yöntem: Birinci basamakta abirateron veya enzalutamid ile tedavi edilen 57 metastatik kastrasyon dirençli (serum testosteron <50 ng/dl) prostat kanseri hastası retrospektif olarak analiz edildi. Görüntülemede ≤3 lezyon olarak tanımlanan oligo-progresif hastalığı olan 39 hasta aynı antiandrojen tedavisine devam edilerek SBRT aldı. Bulgular: Medyan yaş 70 (dağılım 40-85) idi. Kastrasyona duyarlı ortamda, hastaların 27’si (%47,4) dosetaksel almıştır. Oligo-progresif metastatik bölgeler 21 (%52,3) hastada kemik, 6 (%15,3) hastada lenf nodu ve 12 (%30,9) hastada visseral metastaz olarak saptandı. Abirateron ve enzalutamid sırasıyla %47,4, %52,6 hastada tercih edildi. SBRT alan ve almayan hastalarda 12 aylık progresyonsuz sağkalım (PFS) %79,0 ve %88,9 idi (p<0,001). Otuz beş (%61,4) hastada SBRT ile ilişkili derece 1-2 toksisite gözlendi. SBRT ayrıca PFS için bağımsız bir risk faktörüydü (p=0,007, HR:15,7; %95 GA 2,05-118,7). Visseral metastazlar, izole kemik metastazları, anti-androjen tedavi seçimi ve Eastern Cooperative Oncology Group (ECOG) performans skalası varlığı, PFS ile istatistiksel olarak anlamlı değildi. SBRT’nin genel sağkalım üzerinde hiçbir etkisi olmamıştır. Sonuç: Oligo-progresyon durumunda tedaviyi değiştirmeden metastaza yönelik SBRT ile tedavi edilen hastalarda sağkalım sonuçları daha kötüydü. Bu nedenle, aynı antiandrojen tedavisine devam edilerek metastaza yönelik SBRT’ye sadece seçilmiş vakalarda öncelik verilmelidir.

Keywords: Stereotaktik vücut radyoterapisi, abiraterone, enzalutamide, kastrasyona dirençli prostat kanseri

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APA

Göktaş Aydın, S., Kutlu, Y., Muğlu, H., Açıkgöz, Ö., Aydın, A., Bilici, A., Ölmez, Ö.F., Ünal, D., Karcı, E., & Yıldız, Ö. (2023). SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT. Journal of Istanbul Faculty of Medicine, 86(2), 117-122. https://doi.org/10.26650/IUITFD.1211556

AMA

Göktaş Aydın S, Kutlu Y, Muğlu H, Açıkgöz Ö, Aydın A, Bilici A, Ölmez Ö F, Ünal D, Karcı E, Yıldız Ö. SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT. Journal of Istanbul Faculty of Medicine. 2023;86(2):117-122. https://doi.org/10.26650/IUITFD.1211556

ABNT

Göktaş Aydın, S.; Kutlu, Y.; Muğlu, H.; Açıkgöz, Ö.; Aydın, A.; Bilici, A.; Ölmez, Ö.F.; Ünal, D.; Karcı, E.; Yıldız, Ö. SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT. Journal of Istanbul Faculty of Medicine, [Publisher Location], v. 86, n. 2, p. 117-122, 2023.

Chicago: Author-Date Style

Göktaş Aydın, Sabin, and Yasin Kutlu and Harun Muğlu and Özgür Açıkgöz and Ahmet Aydın and Ahmet Bilici and Ömer Fatih Ölmez and Dilek Ünal and Ebru Karcı and Özcan Yıldız. 2023. “SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT.” Journal of Istanbul Faculty of Medicine 86, no. 2: 117-122. https://doi.org/10.26650/IUITFD.1211556

Chicago: Humanities Style

Göktaş Aydın, Sabin, and Yasin Kutlu and Harun Muğlu and Özgür Açıkgöz and Ahmet Aydın and Ahmet Bilici and Ömer Fatih Ölmez and Dilek Ünal and Ebru Karcı and Özcan Yıldız. “SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT.” Journal of Istanbul Faculty of Medicine 86, no. 2 (Jun. 2025): 117-122. https://doi.org/10.26650/IUITFD.1211556

Harvard: Australian Style

Göktaş Aydın, S & Kutlu, Y & Muğlu, H & Açıkgöz, Ö & Aydın, A & Bilici, A & Ölmez, ÖF & Ünal, D & Karcı, E & Yıldız, Ö 2023, 'SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT', Journal of Istanbul Faculty of Medicine, vol. 86, no. 2, pp. 117-122, viewed 21 Jun. 2025, https://doi.org/10.26650/IUITFD.1211556

Harvard: Author-Date Style

Göktaş Aydın, S. and Kutlu, Y. and Muğlu, H. and Açıkgöz, Ö. and Aydın, A. and Bilici, A. and Ölmez, Ö.F. and Ünal, D. and Karcı, E. and Yıldız, Ö. (2023) ‘SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT’, Journal of Istanbul Faculty of Medicine, 86(2), pp. 117-122. https://doi.org/10.26650/IUITFD.1211556 (21 Jun. 2025).

MLA

Göktaş Aydın, Sabin, and Yasin Kutlu and Harun Muğlu and Özgür Açıkgöz and Ahmet Aydın and Ahmet Bilici and Ömer Fatih Ölmez and Dilek Ünal and Ebru Karcı and Özcan Yıldız. “SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT.” Journal of Istanbul Faculty of Medicine, vol. 86, no. 2, 2023, pp. 117-122. [Database Container], https://doi.org/10.26650/IUITFD.1211556

Vancouver

Göktaş Aydın S, Kutlu Y, Muğlu H, Açıkgöz Ö, Aydın A, Bilici A, Ölmez ÖF, Ünal D, Karcı E, Yıldız Ö. SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT. Journal of Istanbul Faculty of Medicine [Internet]. 21 Jun. 2025 [cited 21 Jun. 2025];86(2):117-122. Available from: https://doi.org/10.26650/IUITFD.1211556 doi: 10.26650/IUITFD.1211556

ISNAD

Göktaş Aydın, Sabin - Kutlu, Yasin - Muğlu, Harun - Açıkgöz, Özgür - Aydın, Ahmet - Bilici, Ahmet - Ölmez, ÖmerFatih - Ünal, Dilek - Karcı, Ebru - Yıldız, Özcan. “SURVIVAL EFFECT OF PALLIATIVE RADIOTHERAPY IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER DEVELOPING OLIGO-PROGRESSION UNDER ANTIANDROGEN TREATMENT”. Journal of Istanbul Faculty of Medicine 86/2 (Jun. 2025): 117-122. https://doi.org/10.26650/IUITFD.1211556

Volume 86, Issue 22023, P. 117-122

TIMELINE

Submitted	29.11.2022
Accepted	06.03.2023
Published Online	30.03.2023

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Journal of Istanbul Faculty of Medicine