oligomets prostate

1. Oligometastatic Prostate Cancer-targeting
with radiation

2. Contents
 Oligometastatic Cancer –definition
 Rationale for metastatic directed therapy
 SABR –studies
 Trials

3. Definition
 No thoughtful/formal staging-UICC 8th edition doesn’t have a
an assigned prognostic group
 <=3 lesions outside pelvis
 <=5 lesions limited to lymph nodes/bones
 <=10 lesions with no visceral involvement
 Select studies defining the same
 Imaging also need to be standardized Tc99>>>PSMA PET-CT
 Synchronous vs Metachronous ?

7. Stereotactic Ablative Radiotherapy (SABR)
 5 studies –retrospective small number
 Most of the targets bones >>some visceral, nodes
 Only take away message is that it’s safe
 No G-III toxicity
 Even G-II quite low
 Local control pretty good –ablative
 Freedom from androgen deprivation 2 studies managed for 2-3 years

8. 2 Trials
 STOMP (Surveillance or metastasis-directed Therapy for
OligoMetastatic Prostate cancer recurrence)
 ORIOLE trial (Observation Versus Stereotactic Ablative
RadiatIOn for OLigometastatic Prostate CancEr)

11. Note
 The STOMP trial showed a trend towards delayed ADT, but
failed to show a reduction in metastatic progression.
An important limitation of both the STOMP
and ORIOLE studies is that the investigators
were unable to account for length-bias and may
well have included metastatic patients with
slower growing disease.

14. (1) a method of external
beam radiotherapy
(EBRT) that
(2) accurately delivers a
(3) high dose of
irradiation in
(4) one or few treatment
fractions to an
(5) extracranial target.
 AAPM Task
Group 101
 ASTRO and ACR
SBRT DEFINITION

16. SBRT spine-mets
 67 yr old male case of Ca Prostate post-op with spine recurrence
(cord compression)-D5-D6 level
 Post tumor decompression/spine stabilization patient planned for
SBRT to D5-D6 level
 RT dose 30 Gy/ 5fx @iso (80 % peripheral dose)