Introduction: Metastasis-directed therapy (MDT) alone may be effective in preventing disease progression and positively affecting overall survival (OS) in oligometastatic prostate cancer (OMPC). Objective: We systematically reviewed the current literature to analyse the biological rationale for integrating MDT into treatment strategies for OMPC and investigate the current evidence on its role in OMPC. Evidence acquisition: MEDLINE/PUBMED and the EMBASE Database were systematically searched to identify eligible reports published up to January 2024. The proceedings of the European Society for Radiotherapy and Oncology, European Society of Medical Oncology, American Society for Radiation Oncology, American Society of Clinical Oncology, European Uro-Oncology Group, and American Urological Association annual meetings were analysed. Results: Eighteen studies published between 2014 and 2024 were selected for the analysis. The studies included 1058 patients treated with metastasis-directed radiotherapy. No statistically significant differences were found in terms of treatment-escalation-free survival between hormone-naïve patients treated with MDT alone and those treated with MDT and hormonal manipulation. By contrast, the combination treatment significantly increased both 2 year and 4 year disease-progression-free survival (DPFS) rates (p-values < 0.00001 and 0.006, respectively). In patients with castration-sensitive disease treated with MDT alone, the estimated 2 year and 4 year OS rates were 96.4% (95% confidence interval [CI], 92.9–100%) and 89.1% (95% CI, 82.3–96.5%), respectively. The estimated 2 year and 4 year overall survival rates in the combination treatment group were 86.1% (95% CI 79.2–93.7%) and 74.8% (95% CI 64.6.3–86.5%), respectively. Conclusions: MDT alone is associated with promising outcomes in OMPC and represents a valuable, valid, and often preferable strategy. Combined with ADT improves significantly disease-progression-free survival, but its impact on overall survival remains uncertain. Given these findings, the decision to incorporate ADT should be tailored to individual patient characteristics and clinical context. Future research should integrate biomarker-based approaches to optimise MDT use and select the best candidates for a multimodal approach.
引言：单纯转移灶定向治疗（MDT）可能有效预防寡转移性前列腺癌（OMPC）的疾病进展，并对总生存期（OS）产生积极影响。目的：我们系统回顾现有文献，分析将MDT整合至OMPC治疗策略的生物学依据，并探讨其在OMPC治疗中的现有证据。证据获取：系统检索MEDLINE/PUBMED和EMBASE数据库，筛选截至2024年1月发表的合格研究报告，同时分析了欧洲放射治疗与肿瘤学会、欧洲肿瘤内科学会、美国放射肿瘤学会、美国临床肿瘤学会、欧洲泌尿肿瘤学组及美国泌尿外科协会年会会议记录。结果：共纳入2014年至2024年间发表的18项研究，涵盖1058例接受转移灶定向放疗的患者。在未接受过激素治疗的患者中，单纯MDT治疗组与MDT联合激素治疗组的治疗升级无生存期无统计学差异。相比之下，联合治疗显著提高了2年及4年无疾病进展生存率（DPFS）（p值分别<0.00001和0.006）。在单纯接受MDT治疗的去势敏感性患者中，预估2年与4年OS率分别为96.4%（95%置信区间[CI] 92.9–100%）和89.1%（95% CI 82.3–96.5%）；联合治疗组的预估2年与4年OS率分别为86.1%（95% CI 79.2–93.7%）和74.8%（95% CI 64.6–86.5%）。结论：单纯MDT在OMPC治疗中展现出良好前景，是一种具有重要价值且常更优选的策略。联合雄激素剥夺治疗（ADT）可显著提升无疾病进展生存率，但对总生存期的影响尚不明确。基于这些发现，是否联合ADT应根据患者个体特征及临床情况制定个体化决策。未来研究应整合生物标志物导向策略，以优化MDT应用并筛选适合多模式治疗的最佳候选人群。
肿瘤(癌症)患者之家