Oligometastatic prostate cancer: time to integrate metastasis-directed therapy
A partir d'une revue systématique de la littérature publiée entre novembre 2023 et mai 2025 (7 essais randomisés de phase II, 574 patients), cette méta-analyse évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, d'un traitement ciblant les métastases d'un cancer de la prostate oligométastatique
Metastasis-directed therapy (MDT) delivered via stereotactic body radiotherapy has gained substantial attention over the past decade. Landmark trials such as STOMP1 and ORIOLE2 fundamentally shifted the management paradigm for metastatic prostate cancer. These pioneering studies showed improved progression-free survival in patients with up to three metastases compared with observation alone (HR 0·60, 95% CI 0·40–0·90 in STOMP; HR 0·30, 0·11–0·81 in ORIOLE). Subsequent phase 2 trials further expanded these findings: the EXTEND trials3,4 reported a progression-free survival benefit in patients with recurrent or de novo metastatic disease (five or fewer lesions) when MDT was added to either intermittent or continuous androgen deprivation therapy (ADT; HR 0·45, 0·30–0·69 in the combined analysis), and the RADIOSA5 study observed improved clinical progression-free survival with stereotactic body radiotherapy plus 6 months of ADT compared with stereotactic body radiotherapy alone (HR 0·43; 0·26–0·72).
The Lancet Oncology , commentaire, 2026