Journal of nuclear medicine : official publication, Society of Nuclear Medicine · 2025
PSMA-Guided Metastasis-Directed Therapy for Oligometastatic Renal Cell Carcinoma: The Proof-of-Concept PEDESTAL Study.
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Udovicich Cristian, Bressel Mathias, Manji Jamil, Ali Muhammad, Au Lewis, Azad Arun A, Buteau James P, Chander Sarat, Chang David, Eapen Renu, Lawrentschuk Nathan, Levy Sidney M, Moon Daniel, Murphy Declan G, Perera Marlon, Shaw Mark, Spain Lavinia, Tran Ben, Hofman Michael S, Siva Shankar
Аннотация
Metastasis-directed therapy (MDT) in oligometastatic renal cell carcinoma (RCC) is typically based on conventional imaging. Prostate-specific membrane antigen (PSMA) PET/CT has shown superiority over conventional imaging. Our objective was to perform a proof-of-concept study to evaluate the efficacy of PSMA-guided MDT in oligometastatic RCC. Methods: A PSMA PET/CT database was queried for oligometastatic RCC patients undergoing MDT from 2014 to 2020. The primary endpoint was progression-free survival. Secondary endpoints included freedom from local progression, freedom from change in systemic therapy strategy, and overall survival. Results: A search of 3,095 PSMA PET/CT scans identified 83 RCC patients and 34 receiving MDT to 60 sites. The median follow-up was 4.1 y. Six patients (18%) had synchronous metastatic disease. The median number of metastases was 1 (interquartile range, 1-2). Common sites included bone (19, 32%) and lung (19, 32%). Radiation therapy was delivered to 56 metastases (93%), including stereotactic ablative body and conventional radiotherapy (38 and 18 metastases, respectively), and 4 (7%) underwent surgery. One-, 3-, and 5-y freedom from local progression was 94% (95% CI, 85%-98%), 85% (95% CI, 69%-94%), and 85% (95% CI, 69%-94%), respectively. One-, 3-, and 5-y overall survival was 88% (95% CI, 71%-95%), 71% (95% CI, 52%-84%), and 64% (95% CI, 45%-79%), respectively. One-, 3-, and 5-y progression-free survival was 47% (95% CI, 30%-63%), 26% (95% CI, 13%-42%), and 8% (95% CI, 2%-22%), respectively. One-, 3-, and 5-y freedom from change in systemic therapy strategy was 76% (95% CI, 57%-87%), 65% (95% CI, 45%-79%), and 43% (95% CI, 19%-65%), respectively. Conclusion: In this proof-of-concept study, PSMA-guided MDT provided durable oncologic outcomes for oligometastatic RCC, even at 5 y. To our knowledge, this study had the first cohort uniformly undergoing PSMA-guided MDT and one of the longest follow-ups of MDT for oligometastatic RCC. With increasing availability, PSMA PET/CT can be rapidly instituted to select patients for MDT and improve outcomes for patients with oligometastatic RCC.