Salvage radiotherapy in patients affected by oligorecurrent pelvic nodal prostate cancer

Ingrosso, Gianluca; Mariucci, C.; Tenti, Maria Valentina; Bini, Vittorio; Alì, Emanuele; Saldi, Simonetta; Palumbo, Isabella; Bellavita, Rita; Aristei, Cynthia

doi:10.1007/s12094-020-02364-0

Cited by 4 publications

(10 citation statements)

References 30 publications

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“…Recently, Ingrosso et al reported on 41 patients with pelvic LN metastases with a 3-year BRFS of 53% and a 3-year radiological progression-free survival of 64%. Again, their study differed from the present analysis in regard to a more heterogenous cohort of patients (almost 40% with RT beforehand), the primarily use of choline PET/CT as staging method, and another definition of PSA relapse (rise to more than 25% above the PSA value pre-sRT) [18]. The prospective "Oligopelvis-GETUG-P07" phase II trial reported a 2-and 3-year progression-free survival (PFS) of 81% and 51%, respectively, and a 2-and 3-year BRFS of 58% and 46%, respectively, in 67 patients with pelvic LN relapse.…”

Section: Discussionmentioning

confidence: 62%

“…They described a 5-year BRFS of 42%. In contrast to the present analysis, all patients received ADT and RT was based on nowadays fairly outdated 11 C-acetate or 18 F-choline PET/CT [17]. Recently, Ingrosso et al reported on 41 patients with pelvic LN metastases with a 3-year BRFS of 53% and a 3-year radiological progression-free survival of 64%.…”

Section: Discussionmentioning

confidence: 69%

“…Progression was again defined differently as two consecutive PSA levels above the level at inclusion or clinical progression thus hampering a direct comparison [19]. In contrast to the mentioned studies evaluating mainly patients with choline PET/CT-based sENRT [16][17][18][19], patients in the present analysis received PSMA-PET/CT-based sENRT which probably explains the comparably good outcomes in this analysis. Nevertheless, despite the promising results of these analyses, the best therapeutic strategy in patients with LN recurrence is still a matter of debate [26] and data comparing ENRT with other treatment strategies are so far sparse.…”

Section: Discussionmentioning

confidence: 89%

“…Pretreatment imaging was performed with 68 Ga-or 18 F-labeled PSMA-PET/CT in 75% ( 68 Ga-PSMA-11) and 25% ( 18 F-PSMA-1007) of patients, respectively. Radiolabeling was performed according to good clinical practice as described previously [21,22].…”

Section: Psma Ligand and Pet/ct Imaging Protocolmentioning

confidence: 99%

“…Also in this subset of patients, RT represents one of the mainstays of treatment even though the radiotherapeutic approach (stereotactic body radiotherapy (SBRT) vs. elective nodal radiotherapy (ENRT)), the role of concomitant ADT and the therapeutic consequences of paraaortic LN involvement are still to be evaluated. As shown in mostly retrospective analyses so far, ENRT seems to be an effective treatment strategy with rare side effects [16][17][18][19]. Most of these analyses included mostly patients prior to the PSMA-PET/CT era and so data on PSMA-PET/CT-based salvage ENRT (sENRT) for LN recurrence after RP are currently still sparse.…”

mentioning

confidence: 99%

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Outcome after PSMA-PET/CT-based salvage radiotherapy for nodal recurrence after radical prostatectomy

Rogowski

Trapp

Bestenbostel

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose Nodal recurrent prostate cancer (PCa) represents a common state of disease, amenable to local therapy. PSMA-PET/CT detects PCa recurrence at low PSA levels. The aim of this study was to evaluate the outcome of PSMA-PET/CT-based salvage radiotherapy (sRT) for lymph node (LN) recurrence. Methods A total of 100 consecutive patients treated with PSMA-PET/CT-based salvage elective nodal radiotherapy (sENRT) for LN recurrence were retrospectively examined. Patients underwent PSMA-PET/CT scan due to biochemical persistence (bcP, 76%) or biochemical recurrence (bcR, 24%) after radical prostatectomy (RP). Biochemical recurrence-free survival (BRFS) defined as PSA < post-RT nadir + 0.2 ng/ml and distant metastasis-free survival (DMFS) were calculated using the Kaplan–Meier method and uni- and multivariate analysis was performed. Results Median follow-up was 37 months. Median PSA at PSMA-PET/CT was 1.7 ng/ml (range 0.1–40.1) in patients with bcP and 1.4 ng/ml (range 0.3–5.1) in patients with bcR. PSMA-PET/CT detected 1, 2, and 3 or more LN metastases in 35%, 23%, and 42%, respectively. Eighty-three percent had only pelvic, 2% had only paraaortic, and 15% had pelvic and paraaortic LN metastases. Cumulatively, a total dose converted to EQD21.5 Gy of 66 Gy (60–70 Gy) was delivered to the prostatic fossa, 70 Gy (66–72 Gy) to the local recurrence, if present, 65.1 Gy (56–66 Gy) to PET-positive lymph nodes, and 47.5 Gy (42.4–50.9 Gy) to the lymphatic pathways. Concomitant androgen deprivation therapy (ADT) was administered in 83% of patients. One-, 2-, and 3-year BRFS was 80.7%, 71.6%, and 65.8%, respectively. One-, 2-, and 3-year DMFS was 91.6%, 79.1%, and 66.4%, respectively. In multivariate analysis, concomitant ADT, longer ADT duration (≥ 12 vs. < 12 months) and LN localization (pelvic vs. paraaortic) were associated with improved BRFS and concomitant ADT and lower PSA value before sRT (< 1 vs. > 1 ng/ml) with improved DMFS, respectively. No such association was seen for the number of affected lymph nodes. Conclusions Overall, the present analysis shows that the so far, unmatched sensitivity and specificity of PSMA-PET/CT translates in comparably high BRFS and DMFS after PSMA-PET/CT-based sENRT for patients with PCa LN recurrence. Concomitant ADT, duration of ADT, PSA value before sRT, and localization of LN metastases were significant factors for improved outcome.

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Section: Discussionmentioning

confidence: 62%