Prognostic impact of nodal relapse in definitive prostate-only irradiation
- 49 Downloads
Whole pelvic irradiation in prostate cancer patients might prevent metastatic spread of cancer cells through lymphatic drainages in patients eligible for definitive radiotherapy, but its use has declined in the last decades in favor of prostate-only irradiation (POI). The aim of our study is to assess the incidence of pelvic lymph nodal relapse and outcome in prostate cancer patients receiving POI.
Materials and methods
Data from 207 consecutive patients were collected. Clinical and treatment variables were collected. Biochemical relapse-free survival (BRFS), pelvic nodal relapse-free survival (PNRFS), distant metastasis-free survival (DMFS), disease-specific survival (DSS) and overall survival (OS) were calculated; analysis of prognostic variables was performed.
Five-year BRFS, PNRFS, DMFS, DSS and OS were, respectively, 90, 98, 96, 97 and 91%. On multivariate analysis, independent negative predictors of BRFS were Gleason score ≥ 7 (HR: 3.25) and PSA nadir ≥ 0.08 (HR: 4.86). Pelvic nodal relapse was not correlated to impaired outcome.
Lymph nodal pelvic relapse occurs in 2% of patients at 5 years and does not correlate with impaired outcome, suggesting the lack of theoretical benefit of a prophylactic nodal irradiation. Tumor biology and response to treatment are the main determinants of outcome.
KeywordsProstate cancer Definitive radiotherapy Whole pelvic irradiation Prostate-only irradiation
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
All the authors listed (Mauro Loi, Luca Incrocci, Isacco Desideri, Pierluigi Bonomo, Beatrice Detti, Gabriele Simontacchi, Daniela Greto, Emanuela Olmetto, Giulio Francolini, Icro Meattini, Lorenzo Livi) report no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants.
- 10.Roach M 3rd, DeSilvio M, Valicenti R, Grignon D, Asbell SO, Lawton C et al (2006) Whole-pelvis, “mini-pelvis”, or prostate-only external beam radiotherapy after neoadjuvant and concurrent hormonal therapy in patients treated in the Radiation Therapy Oncology Group 9413 trial. Int J Radiat Oncol Biol Phys 66:647–653CrossRefPubMedGoogle Scholar
- 13.Lawton CA, DeSilvio M, Roach M 3rd et al (2007) An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys 69:646–655CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Roach M 3rd, Marquez C, Yuo HS, Narayan P, Coleman L, Nseyo UO, Navvab Z, Carroll PR (1994) Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 28:33–37CrossRefPubMedGoogle Scholar
- 16.Roach M 3rd, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, Sandler H (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65:965–974CrossRefPubMedGoogle Scholar
- 19.Ost P, Jereczek-Fossa BA, As NV, Zilli T, Muacevic A, Olivier K, Henderson D, Casamassima F, Orecchia R, Surgo A, Brown L, Tree A, Miralbell R, De Meerleer G (2016) Progression-free survival following stereotactic body radiotherapy for oligometastatic prostate cancer treatment-naive recurrence: a multi-institutional analysis. Eur Urol 69:9–12CrossRefPubMedGoogle Scholar
- 22.Zaorsky NG, Hurwitz MD, Keith SW, Dicker AP, Den RB (2013) Evaluation of biologically equivalent dose escalation, clinical outcome, and toxicity in prostate cancer radiation therapy: a meta-analysis of 12,000 patients from 40 institutions. Int J Radiat Oncol 87(S24):26Google Scholar
- 29.Anderson PR, Hanlon AL, Patchefsky A, Al-Saleem T, Hanks GE (1998) Perineural invasion and Gleason 7–10 tumors predict increased failure in prostate cancer patients with pretreatment PSA < 10 ng/ml treated with conformal external beam radiation therapy. Int J Radiat Oncol Biol Phys 41:1087–1092CrossRefPubMedGoogle Scholar
- 34.Lee BH, Kibel AS, Ciezki JP, Klein EA, Reddy CA, Yu C et al (2015) Are biochemical recurrence outcomes similar after radical prostatectomy and radiation therapy? Analysis of prostate cancer-specific mortality by nomogram-predicted risks of biochemical recurrence. Eur Urol 67:204–209CrossRefPubMedGoogle Scholar