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The Role of SBRT in Oligometastatic Prostate Cancer: Where We Are and Where We Are Heading
Macarena Teja1,2,3, Miguel Angel Berenguer Frances4,5, Fernando López Campos1,6
1Department of Radiation Oncology, GenesisCare-Vithas La Milagrosa University Hospital, 28010 Madrid, Spain.
Abstract:
Oligometastatic prostate cancer represents a distinct biological state between localized and widely metastatic disease, characterized by a limited number of lesions. Stereotactic body radiotherapy (SBRT) has emerged as a key metastasis-directed therapy (MDT), enabling precise ablation of metastatic lesions with minimal toxicity. Prospective clinical trials such as SABR-COMET, STOMP, ORIOLE, RADIOSA, and EXTEND have shown that SBRT delays disease progression, prolongs progression-free survival, and postpones the need for systemic therapy, while maintaining a favorable safety profile. Nevertheless, methodological limitations persist, including heterogeneity in defining oligometastatic disease, variability in dosing and fractionation, and the lack of predictive biomarkers. Ongoing phase III trials aim to validate the integration of SBRT with modern systemic therapies, including next-generation androgen receptor pathway inhibitors, to optimize clinical outcomes in hormone-sensitive and castration-resistant oligometastatic prostate cancer. This review summarizes current evidence, clinical applications, and future directions for SBRT in this patient population.
Insights
Stereotactic body radiotherapy (SBRT) effectively treats oligometastatic prostate cancer, delaying progression and reducing the need for systemic therapy. Further research is refining SBRT integration with advanced treatments for better patient outcomes.
Area of Science:
- Oncology
- Radiation Oncology
- Urologic Oncology
Background:
- Oligometastatic prostate cancer is an intermediate stage between localized and widespread metastatic disease.
- Stereotactic body radiotherapy (SBRT) is a precise metastasis-directed therapy (MDT) for limited metastatic lesions.
- SBRT offers minimal toxicity in treating oligometastatic prostate cancer.
Purpose of the Study:
- To review the current evidence and clinical applications of SBRT for oligometastatic prostate cancer.
- To discuss the role of SBRT in delaying disease progression and postponing systemic therapy.
- To explore future directions and ongoing trials investigating SBRT in combination with systemic therapies.
Main Methods:
- Review of prospective clinical trials (SABR-COMET, STOMP, ORIOLE, RADIOSA, EXTEND).
- Analysis of SBRT's efficacy in prolonging progression-free survival.
- Evaluation of SBRT's safety profile in hormone-sensitive and castration-resistant prostate cancer.
Main Results:
- SBRT has demonstrated efficacy in delaying disease progression and extending progression-free survival.
- SBRT postpones the need for systemic therapy in patients with oligometastatic prostate cancer.
- SBRT maintains a favorable safety profile, with minimal toxicity.
Conclusions:
- SBRT is a valuable metastasis-directed therapy for oligometastatic prostate cancer.
- Methodological limitations like defining oligometastatic disease and lack of biomarkers need addressing.
- Ongoing trials are crucial for integrating SBRT with novel systemic therapies to optimize outcomes.
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