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The purpose of this study was to evaluate the efficacy, safety and toxicity of extracranial stereotactic body radiotherapy (SBRT) for lymph node oligometastatic/recurrent/persistent prostate cancer (PCa)

Patients included in this analysis had ≤ 3 metastatic sites and underwent SBRT on nodal metastases.
The endpoints were local control of treated metastases (LC), distant local control (DLC), progression-free survival (PFS), overall survival (OS), distant metastases free survival (DMFS). Acute and delayed toxicities were also evaluated.

Thirty-nine patients carrying out 62 nodal metastases were analyzed. In 16 patients androgen deprivation (AD) was combined with SBRT. Fifty-three lesions (85.4%) were treated by SBRT (multiple fractions), and 9 (14.2%) lesions were treated by single fraction radiotherapy (SRS). The median dose delivered by SBRT was 45 Gy (range 24-50 Gy) with a median BEDα/β10 of 48 Gy (range 45-95.2 Gy). The most frequent schedula for SBRT was 6 Gy x 5 fractions (46%). The median dose delivered by SRS was 12 Gy (range 8-30 Gy), with a median BEDα/β10 of 71.4 Gy (range 33.6-120). The most frequently adopted schedule for SRS was 12 Gy x 1 fraction (33.3%). After a median follow-up of 30 months (range 5 – 116), median PSA decreased from 5.4 ng/ml (range=4.2–9.6 ng/ml) (values at diagnosis) to 0.21 ng/ml (range=0.05–2.28ng/ml) (values at the last follow-up).The LC rate at three and five years was 98% and 93.5%, respectively. The observed median of DNC was 28 months with a five-year rate of 81.9% The median PFS was 12 months; the three-year PFS rate was 33.9%. The median DMFS was 28 months; the five-year DMFS rate was 56.9%. Median OS was 30 months. No grade III or IV toxicity was reported.

The present study shows the efficacy of SBRT in oligometastatic/persistent/recurrent prostate cancer patients and allows to achieve good results in terms of clinical outcomes with poor toxicity