文章：

阿帕鲁胺联合立体定向体部放疗治疗转移性激素敏感性前列腺癌：多中心真实世界研究

Apalutamide and Stereotactic Body Radiotherapy in Metastatic Hormone-Sensitive Prostate Cancer: Multicenter Real-World Study

原文发布日期：2 July 2025

DOI: 10.3390/cancers17132216

类型: Article

开放获取: 是

英文摘要：

Background: The management of metastatic hormone-sensitive prostate cancer (mHSPC) has evolved with the integration of androgen receptor signaling inhibitors (ARSIs) and metastasis-directed therapies (MDTs). Stereotactic body radiotherapy (SBRT) offers precise local control, yet real-world data on its combination with apalutamide remain limited. Methods: We conducted a multicenter retrospective cohort study including 134 patients with mHSPC treated with apalutamide and SBRT between February 2021 and December 2024. The primary endpoints were progression-free survival (PFS), local control (LC), and treatment safety. PSA kinetics and radiologic response were evaluated, and outcomes were analyzed according to PSA thresholds and treatment timing. Results: Most patients (93.3%) had low-volume disease; 97.1% presented with ≤5 metastases. At a median follow-up of 28 months, LC was 99.3% and 95.5% of patients were progression-free. Complete radiological response was achieved in 87.5% of patients, and 68.4% attained ultralow PSA levels (≤0.02 ng/mL). Undetectable PSA and radiologic complete response were independently associated with improved PFS (p= 0.010 andp= 0.011, respectively). Treatment was well tolerated, with grade ≥3 toxicity occurring in only 2.2% of patients. Conclusions: The combination of apalutamide and SBRT in mHSPC is associated with high local and systemic disease control and minimal toxicity in a real-world setting. This approach may delay systemic treatment intensification and the onset of castration resistance. Prospective studies are warranted to confirm these findings.

摘要翻译： 

背景：转移性激素敏感性前列腺癌（mHSPC）的治疗随着雄激素受体信号抑制剂（ARSIs）和转移灶定向治疗（MDTs）的整合而不断发展。立体定向体部放疗（SBRT）可提供精准的局部控制，但其与阿帕他胺联合应用的真实世界数据仍然有限。方法：我们开展了一项多中心回顾性队列研究，纳入了2021年2月至2024年12月期间接受阿帕他胺联合SBRT治疗的134例mHSPC患者。主要终点是无进展生存期（PFS）、局部控制率（LC）和治疗安全性。评估了PSA动力学和影像学反应，并根据PSA阈值和治疗时机对结果进行了分析。结果：大多数患者（93.3%）为低瘤负荷；97.1%的患者转移灶≤5个。中位随访28个月时，局部控制率为99.3%，95.5%的患者无疾病进展。87.5%的患者达到影像学完全缓解，68.4%的患者达到超低PSA水平（≤0.02 ng/mL）。PSA检测不到和影像学完全缓解均与改善的PFS独立相关（分别为p=0.010和p=0.011）。治疗耐受性良好，仅2.2%的患者发生≥3级毒性。结论：在真实世界环境中，阿帕他胺联合SBRT治疗mHSPC与较高的局部和全身疾病控制率以及极低的毒性相关。该方法可能延迟强化全身治疗和去势抵抗的发生。有必要进行前瞻性研究以证实这些发现。

原文链接：

Apalutamide and Stereotactic Body Radiotherapy in Metastatic Hormone-Sensitive Prostate Cancer: Multicenter Real-World Study