The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial

A Phase 1 Trial of Highly Conformal, Hypofractionated Postprostatectomy Radiation Therapy

“…Finally, emerging data appears to suggest a benefit for pelvic nodal irradiation in some patients with prostate cancer. The preliminary results of RTOG 0534 (SPPORT) reported an increased freedom from progression at a median follow-up of 8.2 years with the inclusion of pelvic lymph node irradiation and short-term ADT to PORT [29]. In the current trial, no patients underwent pelvic nodal irradiation.…”

“…These consisted of one patient with self-resolving cystitis and a second with an exacerbation of baseline grade 2 incontinence. This rate of late toxicity is higher than that expected for conventional fractionation; contemporary phase III trials such as SAKK 09/10 [25] and RTOG 0534 [29] report rates of late grade 3+ GU toxicity within the range of 5.3% to 7.9% in patients undergoing post-operative, prostate bed-directed, salvage radiotherapy. The preliminary results of a recent phase III noninferiority trial, NRG GU003, designed to compare the 2-year EPIC-26 QoL scores of a more protracted hypofractionated regimen than in our trial (62.5Gy in 25 fractions) and a conventionally fractionated regimen (66.6Gy in 37 fractions) also showed a possible signal of grade 3 adverse events in the hypofractionated arm with a 4.7% rate of grade 3 cystitis as compared to 0% in the conventionally fractionated arm [12].…”

The cost of elective nodal coverage in prostate cancer: Late quality of life outcomes and dosimetric analysis with 0, 45 or 54 Gy to the pelvis

“…As in the definitive setting, the morbidity of adding PLNRT to the prostate fossa is unclear [16] , [20] , [21] , [22] , though it is offered by most physicians [23] . Findings from NRG Oncology/RTOG 0534 SPORRT seem to support this practice, demonstrating lower rates of progression with PLNRT [24] .…”

Fractionation Choice for Elective Lymph Node Radiation Therapy in Prostate Cancer: Slightly More to CHIRP About

“…Further data come from the SPPORT trial, which in the salvage setting showed increased acute gastrointestinal (GI) toxic effects but no differences in late bowel or bladder toxic effects with the addition of PLN radiation therapy (45 Gy in 25 Fr to PLN, 87% IMRT). 6 Interestingly, bone marrow toxic effects (both acute and late) were worse with nodal radiation therapy in SPPORT, an endpoint not reported in the PIVOTAL or POP-RT trials. With conventionally fractionated radiation therapy to the pelvis appearing to produce generally acceptable toxic effects, we can then consider hypofractionated radiation therapy.…”