Metastasis-directed Therapy of Regional and Distant Recurrences After Curative Treatment of Prostate Cancer: A Systematic Review of the Literature

摘要: Abstract Context The introduction of novel imaging modalities has increased the detection oligometastatic prostate cancer (PCa) recurrence, potentially justifying use a metastasis-directed therapy (MDT) with surgery or radiotherapy (RT) rather than systemic approach. Objective To perform systematic review MDT for PCa recurrence. Evidence acquisition This was performed according to Preferred Reporting Items Systematic Reviews and Meta-analysis guidelines. We searched Medline Embase databases from 1946 February 2014 studies reporting on biochemical clinical progression and/or toxicity complications (RT surgery). Reports were excluded if these end points could not be ascertained separately analysed, insufficient details provided. Methodological quality assessed using an 18-item validated appraisal tool case series. synthesis Fifteen single-arm series total 450 patients met inclusion criteria. Seven considered acceptable quality. Oligometastatic recurrence diagnosed positron emission tomography coregistered computed in most (98%). Nodal, bone, visceral metastases treated 78%, 21%, 1%, respectively. Patients either RT (66%) lymph node dissection (LND) (34%). Adjuvant androgen deprivation given 61% ( n =275). In nodal metastases, prophylactic irradiation administered 49% =172). Overall, 51% free 1–3 yr after salvage MDT, them receiving adjuvant treatment. For RT, grade 2 observed 8.5% patients, one 3 toxicity. LND, 11% 12% complications, respectively, reported. Conclusions is promising approach but low level evidence generated by small does allow extrapolation standard care. Patient summary assess outcomes treating radiotherapy. concluded that although this promising, it requires validation randomised controlled trials.