Salvage therapy of small volume prostate cancer nodal failures: A review of the literature

Is Stereotactic Body Radiotherapy (SBRT) in lymph node oligometastatic patients feasible and effective?

“…Out of 7 review articles, only 1 is dedicated exclusively to the lymph node SBRT, 8 and 2 describe treatment options for lymph node recurrence including SBRT. 11,12 Thirty one clinical series reporting treatment outcome (in the series of 1-69 cases of lymph node recurrence) were divided in those including patients treated with SBRT only for lymph node recurrent cancer (12 articles) [32][33][34][35][36][37][38][39][40][41][42][43] and those on the patients treated for any oligometastatic cancer to any sites including lymph nodes (19 articles). [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The first article of this series was published in 2005.…”

Targeted local therapy in oligometastatic prostate cancer: a promising potential opportunity after failed primary treatment

“…The sensitivity of conventional CT and MRI detection of LN metastases ranges between 25% and 78% and 0-86%, respectively; MRI being significantly more accurate than CT at detecting small LNs (1-5mm) [3]. However, given metastatic disease may occur in 25% of normal sized LNs , reliance on size criteria alone to predict metastatic involvement of LNs may result in significant underestimation of disease burden.…”

“…Metaanalysis of 18 F-choline and 11 C-choline PET or PET/CT in LN staging of prostate cancer reported pooled sensitivity and specificity of 49.2% and specificity of 95%, respectively [3]. Early evidence suggests DWI-MRI may be more accurate than size-based criteria in conventional MRI, but is not conclusive at this stage [3].…”

“…The Southwest Oncology Group (SWOG)-Intergroup trial showed a 32% locoregional recurrence rate with ≥pT3 disease, a 29% rate with pN+ disease, and a 68% rate when margins were positive, with no reduction in local failure with neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy [2]. The MD Anderson experience with clinically staged patients, most of whom received chemotherapy, revealed 5-year local failure rates of 29% and 44%, respectively, for stage cT3b and cT4 disease [3]. In a retrospective review of patients with local recurrence after RC, Honma et al [4] found local recurrences were independent of pathological stage, number of nodes retrieved,…”

“…Despite early evidence suggesting improved accuracy with these investigations in some settings, further research is needed to clearly define indications for each mrethod, including appropriate PSA thresholds. Meanwhile, patient selection and treatment planning for targeted local therapy must consider that current available imaging techniques may significantly underestimate the extent of recurrence [3,4].…”