Local control after locally ablative, image-guided radiotherapy of oligometastases identified by Gallium-68-PSMA-Positron Emission Tomography in castration-sensitive prostate cancer patients (OLI-P)

Progression of prostate-specific antigen (PSA) values after curative treatment of prostate
cancer patients is common. Prostate-specific membrane antigen (PSMA-) PET imaging can identify
patients with metachronous oligometastatic disease even at low PSA levels. Metastases-directed
local ablative radiotherapy (aRT) has been shown to be a safe treatment option. In this prospective
clinical trial, we evaluated local control and the pattern of tumor progression. Between 2014 and 2018,
63 patients received aRT of 89 metastases (MET) (68 lymph node (LN-)MET and 21 bony (OSS-)MET)
with one of two radiation treatment schedules: 50 Gy in 2 Gy fractions in 34 MET or 30 Gy in 10 Gy
fractions in 55 MET. The mean gross tumor volume and planning target volume were 2.2 and 14.9 mL,
respectively. The median follow-up time was 40.7 months. Local progression occurred in seven MET,
resulting in a local control rate of 93.5% after three years. Neither treatment schedule, target volume,
nor type of lesion was associated with local progression. Regional progression in the proximity to the
LN-MET was observed in 19 of 47 patients with at least one LN-MET (actuarial 59.3% free of regional
progression after 3 years). In 33 patients (52%), a distant progression was reported. The median time
to first tumor-related clinical event was 16.6 months, and 22.2% of patients had no tumor-related
clinical event after three years. A total of 14 patients (22%) had another aRT. In conclusion, local
ablative radiotherapy in patients with PSMA-PET staged oligometastatic prostate cancer may achieve
local control, but regional or distant progression is common. Further studies are warranted, e.g., to
define the optimal target volume coverage in LN-MET and OSS-MET.