Bridging the gap between Radiotherapy and mHSPC – Andrea Lancia
Andrea Lancia, Radiation Oncologist at Fondazione IRCCS Polilcinico San Matteo, shared article about Prostate Cancer and the role of Radiation Therapy with OncoDaily:
“We have witnessed a momentous advancement in the therapeutic management of metastatic prostate cancer during the last twenty years, with the approval of several drugs for use in the clinics which lead to prolonged survival and better quality of life for a group of patients historically experiencing poor outcomes.
This enlarged treatment armamentarium, which includes a variety of molecules that differs substantially from each other in terms of mechanism of action, has started moving earlier in the prostate cancer continuum from the castration resistant to the hormone sensitive stage of disease.
At the same time, evidence has been mounting for radiotherapy also in the setting of stage IV prostate cancer, beyond its sweet spot as a major curative approach for the localised disease. Both Arm H of the STAMPEDE trial, and a subgroup analysis of the HORRAD indicate that the addition of RT to androgen suppression results in overall survival benefits for metastatic patients with a low burden of disease receiving radiation to the primitive tumor. Furthermore, recently published data suggests considering radiotherapy as an option for metastatic hormone-sensitive prostate cancer patients as it has been shown to reduce the occurrence of serious genitourinary events, regardless of metastatic burden, and delay the time to castration resistance and radiographic progression of disease.
Despite not having the same level of evidence, multiple phase II trials have demonstrated that targeting the sites of metastasis in oligometastatic patients leads to excellent local control of disease, improved outcomes, and delay of progression.
Authors: Andrea Lancia, Anna Rita Alitto, Giovanni Pappagallo, Elisa Ciurlia, Giulio Francolini, Rolando D’Angelillo, Sergio Fersino, Niccolò Giaj Levra, Barbara Alicja Jereczek-Fossa, Alessandro Magli, Francesco Pasqualetti, Alessia Reali, Corrado Spatola and Luca Triggiani.
However, such a rapidly evolving therapeutic scenario does not reflect every day clinical practice. There are heterogeneous attitudes within the Rad Onc Community towards this relatively new role of radiotherapy in the setting of metastatic prostate cancer, with several issues that need to be addressed.
To overcome these issues and to provide clinicians with a useful tool for their daily practice, the Italian Association of Radiotherapy and Oncology (AIRO) assembled a panel of GU experts with the aim of precislely defining the growing role of radiotherapy in the setting of metastatic Hormone Sensitive Prostate Cancer.
Thirteen radiation oncologists under the supervision of a senior epidemiologist (as supervisor) were involved in the project which was developed in the form of Estimate-Talk-Estimate project. Seven conclusive items were matter of debate, with a final consensus reached in the form of twelve specific statements.”
Learn more about Metastatic Prostate Cancer by visiting OncoDaily.
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