Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy

Song, Choong Eui; Kang, Hyun-Cheol; Kim, Jae Sung; Eom, Keun Yong; Kim, In Ah; Chung, Jae Yoon; Hong, Sung Kyu; Byun, Seok‐Soo; Lee, Sang Eun

doi:10.1007/s00066-015-0872-9

Cited by 15 publications

(6 citation statements)

References 37 publications

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“…For selected, high-risk patients, WPRT is often used to irradiate pelvic lymph nodes, which may harbor occult metastases [11, 22]. This study furthers understanding of the clinical implications of BCR after RP and the treatment effect of WPRT during SRT, confirming the results of previous studies demonstrating that WPRT (with or without ADT) can reduce the incidence of subsequent secondary biochemical relapse [11, 13]. With regard to the potential increase in toxicity following WPRT compared with PBRT in the postprostatectomy RT setting, several studies have demonstrated that the risk of developing late GI toxicity is significantly reduced with intensity modulated radiotherapy compared with three-dimensional conformal radiotherapy [15, 23, 24].…”

Section: Discussionsupporting

confidence: 79%

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Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis

et al. 2019

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Purpose To investigate whether whole pelvic radiotherapy (WPRT) improves biochemical relapse-free survival (bRFS) vs. prostate bed radiotherapy (PBRT) in prostate cancer patients receiving salvage radiotherapy (SRT) after radical prostatectomy. Methods Data from patients with prostate cancer who underwent SRT for biochemical recurrence between 2005 and 2012 in two academic institutions were retrospectively reviewed. Patients treated with WPRT in one hospital were compared with patients treated with PBRT in the other. Propensity scoring was performed to balance the characteristics of the different treatment groups, and bRFS was compared. Results Data from a total of 191 patients were included in the analysis (WPRT, n = 108; PBRT, n = 83). The median follow-up period was 66 months. Prior to matching, patients who received WPRT had higher pathologic Gleason scores as well as a higher incidence of pre-SRT PSA levels >0.5 ng/mL and lower rates of concurrent androgen-deprivation therapy. Propensity score matching balanced these characteristics and generated a cohort comprising 56 patients from each group. In the matched cohort, the 5 year bRFS of the WPRT group was significantly higher than that of the PBRT group (65.9 vs. 42.2%, p = 0.017). Multivariate analysis revealed that WPRT was an independent prognostic factor for bRFS (hazard ratio: 0.45, 95% confidence interval: 0.26–0.75, p = 0.002). This benefit of WPRT on bRFS was maintained in subgroup analyses, especially in patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL. Conclusions These data suggest that, following radical prostatectomy, elective WPRT during SRT may improve bRFS compared with PBRT in selected patients. Patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL represent a potential subgroup who benefit most from receiving WPRT. Results of prospective randomized trials are awaited to confirm this finding.

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Section: Discussionsupporting

confidence: 79%

“…Patients subsequently underwent either PBRT or WPRT. Details of the radiation technique used have been described previously [13–15]. In brief, the clinical target volume (CTV) of WPRT included prostate bed, seminal vesicle, and presacral, obturator, internal iliac, and external iliac nodal regions.…”

Section: Methodsmentioning

confidence: 99%

Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis

et al. 2019

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“…WPRT doses in recent studies ranged from 40 to 54 Gy. WPRT was associated with a bPFS benefit in some studies [26, 29, 30] while others described an association limited to subgroups [28] or found no association at all [27, 32]. The strongest but not yet fully published evidence so far in support of combining PBRT and WPRT comes from an interim analysis of the RTOG-0534/SPPORT trial which showed significantly different 5-year failure-free survival rates between PBRT, PBRT plus ADT and WPRT plus ADT arms of 71.7, 82.7 and 89.1%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Postoperative elective pelvic nodal irradiation compared to prostate bed irradiation in locally advanced prostate cancer – a retrospective analysis of dose-escalated patients

et al. 2019

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Background It is uncertain if whole-pelvic irradiation (WPRT) in addition to dose-escalated prostate bed irradiation (PBRT) improves biochemical progression-free survival (bPFS) after prostatectomy for locally advanced tumors. This study was initiated to analyze if WPRT is associated with bPFS in a patient cohort with dose-escalated (> 70 Gy) PBRT. Methods Patients with locally advanced, node-negative prostate carcinoma who had PBRT with or without WPRT after prostatectomy between 2009 and 2017 were retrospectively analyzed. A simultaneous integrated boost with equivalent-doses-in-2-Gy-fractions (EQD-2) of 79.29 Gy or 71.43 Gy to the prostate bed was applied in patients with margin-positive (or detectable) and margin-negative/undetectable tumors, respectively. WPRT (44 Gy) was offered to patients at an increased risk of lymph node metastases. Results Forty-three patients with PBRT/WPRT and 77 with PBRT-only were identified. Baseline imbalances included shorter surgery-radiotherapy intervals (S-RT-Intervals) and fewer resected lymph nodes in the WPRT group. WPRT was significantly associated with better bPFS in univariate ( p = 0.032) and multivariate models (HR = 0.484, p = 0.015). Subgroup analysis indicated a benefit of WPRT ( p = 0.029) in patients treated with rising PSA values who mostly had negative margins (74.1%); WPRT was not associated with a longer bPFS in the postoperative setting with almost exclusively positive margins (96.8%). Conclusion We observed a longer bPFS after WPRT compared to PBRT in patients with locally advanced prostate carcinoma who underwent dose-escalated radiotherapy. In subset analyses, the association was only observed in patients with rising PSA values but not in patients with non-salvage postoperative radiotherapy for positive margins. Electronic supplementary material The online version of this article (10.1186/s13014-019-1301-5) contains supplementary material, which is available to authorized users.

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“…In the salvage setting, the results of RTOG 0534 (NCT00567580) comparing SRT alone versus SRT plus short-term ADT versus SRT, short-term ADT and pelvic lymph node radiotherapy are eagerly awaited. Our survey reflects the uncertainties in the use of elective radiation to the pelvic nodes [30]. Of the participating centers 43% responded that they treat the pelvis according to the presence of high-risk disease (a definition that was not uniform), the presence of pN1 or according to the extent of previous lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

Salvage radiotherapy for macroscopic local recurrences after radical prostatectomy

et al. 2017

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Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy

Abstract: Elective WPRT for SRT may improve bRFS in patients with unfavorable risk factors. These results need to be confirmed by a prospective randomized trial.

Cited by 15 publications

References 37 publications

Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis

Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis

Postoperative elective pelvic nodal irradiation compared to prostate bed irradiation in locally advanced prostate cancer – a retrospective analysis of dose-escalated patients

Salvage radiotherapy for macroscopic local recurrences after radical prostatectomy

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