Oligometastatic prostate cancer is a new and emerging treatment field with only few prospective randomized studies published so far. Despite the lack of strong level I evidence, metastasis-directed therapies (MDT) are widely used in clinical practice, mainly based on retrospective and small phase 2 studies and with a large difference across centers. Pending results of ongoing prospective randomized trials, there is a clear need for more consistent treatment indications and radiotherapy practices.
A European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee consisting of radiation oncologists' experts in prostate cancer was asked to answer a dedicated questionnaire, including 41 questions on the main controversial issues with regard to oligometastatic prostate cancer.
The panel achieved consensus on patient selection and routine use of prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging as preferred staging and restaging imaging. MDT strategies are recommended in the de novo oligometastatic, oligorecurrent and oligoprogressive disease setting for nodal, bone and visceral metastases. Radiation therapy doses, volumes and techniques were discussed and commented.
These recommendations have the purpose of providing standardization and consensus to optimize the radiotherapy treatment of oligometastatic prostate cancer until mature results of randomized trials are available.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2022 Oct 10 [Epub ahead of print]
Thomas Zilli, Vérane Achard, Alan Dal Pra, Nina Schmidt Hegemann, Barbara Alicja Jereczek-Fossa, Andrea Lancia, Gianluca Ingrosso, Filippo Alongi, Shafak Aluwini, Stefano Arcangeli, Pierre Blanchard, Antonio Conde Moreno, Felipe Couñago, Gilles Créhange, Piet Dirix, Alfonso Gomez Iturriaga, Matthias Guckenberger, David Pasquier, Paul Sargos, Marta Scorsetti, Stéphane Supiot, Alison C Tree, Almudena Zapatero, Jennifer Le Guevelou, Piet Ost, Claus Belka
Department of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland and Faculty of Medicine, Geneva University, Geneva, Switzerland. Electronic address: Thomas.Zilli@eoc.ch., Department of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland., Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida., Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany., Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy and Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Radiation Oncology, Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy., Department of Radiation Oncology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy., Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar di Valpolicella, Italy, University of Brescia, Brescia, Italy., Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands., Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy., Department of Radiation Oncology, Gustave Roussy, Oncostat Inserm U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif, France Gustave-Roussy, Villejuif, France., Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, CEU Cardenal Herrera University, Castellón, Spain., Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid, Spain, Department of Radiation Oncology, Hospital La Luz, Madrid, Spain, Medicine Department, School of Biomedical Sciences, Universidad Europea, Villaviciosa de Odón, Madrid, Spain., Department of Radiation Oncology, Institut Curie, Paris, France., Department of Radiation-Oncology, Iridium Network, Antwerp, Belgium., Biocruces Health Research Institute, Cruces University Hospital, Basque Country University (UPV/EHU), Barakaldo, Bizkaia, Spain., Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland., Academic department of Radiation Oncology, Centre Oscar Lambret, Lille, France and CRIStAL UMR CNRS 9189, Lille University, Lille, France., Department of Radiotherapy, Institut Bergonié, Bordeaux, France., Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy., Department of Radiation Oncology, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France., Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom., Department of Radiation Oncology, Health Research Institute, University Hospital La Princesa, Madrid, Spain., Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland and Faculty of Medicine, Geneva University, Geneva, Switzerland., Department of Human structure and repair, Ghent University, Ghent, Belgium and Department of Radiation Oncology, Iridium network, GZA ziekenhuizen, Wilrijk Belgium.