The DEGRO Expert Commission on Prostate Cancer has revised the indication for radiation therapy of the primary prostate tumor in patients with synchronous distant metastases with low metastatic burden.
The current literature in the PubMed database was reviewed regarding randomized evidence on radiotherapy of the primary prostate tumor with synchronous low metastatic burden.
In total, two randomized trials were identified. The larger study, the STAMPEDE trial, demonstrated an absolute survival benefit of 8% after 3 years for patients with low metastatic burden treated with standard of care (SOC) and additional radiotherapy (RT) (EQD2 ≤ 72 Gy) of the primary tumor. Differences in the smaller Horrad trial were not statistically significant, although risk reduction in the subgroup (< 5 bone metastases) was equal to STAMPEDE. The STOPCAP meta-analysis of both trials demonstrated the benefit of local radiotherapy for up to 4 bone lesions and an additional subanalysis of STAMPEDE also substantiated this finding in cases with M1a-only metastases.
Therefore, due to the survival benefit after 3 years, current practice is changing. New palliative SOC is radiotherapy of the primary tumor in synchronously metastasized prostate cancer with low metastatic burden (defined as ≤ 4 bone metastases, with or without distant nodes) or in case of distant nodes only detected by conventional imaging.
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. 2022 Jun 15 [Epub ahead of print]
Arndt-Christian Müller, Daniel M Aebersold, Clemens Albrecht, Dirk Böhmer, Michael Flentje, Ute Ganswindt, Pirus Ghadjar, Nina-Sophie Schmidt-Hegemann, Stefan Höcht, Tobias Hölscher, Peter Niehoff, Michael Pinkawa, Felix Sedlmayer, Frank Wolf, Constantinos Zamboglou, Daniel Zips, Thomas Wiegel, Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party Radiation Oncology of the German Cancer Society (DKG-ARO)
Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany. ., Department of Radiation Oncology Inselspital, University of Bern, Bern, Switzerland., Klinik für Strahlentherapie, Klinikum Nürnberg Nord, Nürnberg, Germany., Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany., Department of Radiation Oncology, Universitätsklinikum Würzburg, Würzburg, Germany., Department of Radiation Oncology, University Hospital Innsbruck, Innsbruck, Austria., Department of Radiation Oncology, LMU Munich, Munich, Germany., Xcare Praxis für Strahlentherapie Saarlouis, Xcare Gruppe, Saarlouis, Germany., Department of Radiotherapy and Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany., Sana Klinikum Offenbach, Offenbach, Germany., MediClin Robert Janker Klinik, Bonn, Germany., Landeskrankenhaus, Universitätsklinikum der Paracelsus Medizinischen Privatuniversität Salzburg, Salzburg, Austria., Department of Radiation Oncology, Universitätsklinikum Freiburg, Freiburg, Germany., Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany., Department of Radiation Oncology, Universitätsklinikum Ulm, Ulm, Germany.