Strahlentherapie und Onkologie

, Volume 191, Issue 4, pp 310–320 | Cite as

Adjuvant radiotherapy after salvage lymph node dissection because of nodal relapse of prostate cancer versus salvage lymph node dissection only

  • Hans Christian Rischke
  • Wolfgang Schultze-Seemann
  • Gesche Wieser
  • Malte Krönig
  • Vanessa Drendel
  • Petra Stegmaier
  • Tobias Krauss
  • Karl Henne
  • Natalia Volegova-Neher
  • Daniel Schlager
  • Simon Kirste
  • Anca-Ligia Grosu
  • Cordula Annette JilgEmail author
Original article



Nodal pelvic/retroperitoneal recurrent prostate cancer (PCa) after primary therapy can be treated with salvage lymph node dissection (salvage-LND) in order to delay disease progression and offer cure for a subset of patients. Whether adjuvant radiotherapy (ART) in affected regions improves the outcome by elimination of residual tumour burden remains unclear.


A total of 93 patients with exclusively nodal PCa relapse underwent choline-positron-emission tomography-computed-tomography-directed pelvic/retroperitoneal salvage-LND; 46 patients had surgery only and 47 patients received ART in regions with proven lymph node metastases. In case of subsequent prostate specific antigen (PSA) progression, different imaging modalities were performed to confirm next relapse within or outside the treated region (TR). Mean follow-up was 3.2 years.


Lymphatic tumour burden was balanced between the two groups. Additional ART resulted in delayed relapse within TR (5-year relapse-free rate 70.7 %) versus surgery only (5-year relapse-free rate 26.3 %, p < 0.0001). In both treatment arms, time to next relapse outside the TR was almost equal (median 27 months versus 29.6 months, p = 0.359). With respect to the detection of the first new lesion, regardless if present within or outside the TR, 5 years after the treatment 34.3 % of patients in the group with additional ART were free of relapse, versus 15.4 % in the surgery only group (p = 0.0122). ART had no influence on the extent of PSA reduction at latest follow-up compared to treatment with surgery only.


ART after salvage-LND provides stable local control in TR and results in overall significant improved next-relapse-free survival, compared to patients who received surgery only in case of nodal PCa-relapse.


Prostate cancer relapse Salvage lymph node dissection Adjuvant radiotherapy Lymph node metastases Salvage radiotherapy 



Adjuvant radiotherapy


Antihormonal therapy


Confidence interval


Computed tomography


Clinical target volume


Image-guided radiotherapy


Intensity-modulated radiotherapy


Lymph nodes


Lymph node metastases


Magnetic resonance imaging


Positron emission tomography/computed tomography


Prostate cancer


Prostate-specific antigen


Planning target volume


Salvage lymph node dissection


Standard deviation




Treated region

Adjuvante Strahlentherapie nach Salvage-Lymphadenektomie beim nodalen Prostatakarzinomrezidiv im Vergleich zur alleinigen Salvage-Lymphadenektomie



Das nodal positive Prostatakarzinom(PCa)-Rezidiv nach Primärtherapie kann durch eine Salvage-Lymphadenektomie (Salvage-LND) therapiert werden. Der Krankheitsprogress wird aufgehalten und selektionierte Patienten erhalten eine zweite Chance auf eine Kuration. Ob eine adjuvante Strahlentherapie (ART Eradikation von verbleibenden Tumorzellen in der betreffenden Region) die Tumorfreiheitsrate verbessert, ist ungeklärt.

Material und Methoden

Insgesamt 93 Patienten mit einem ausschließlich nodalen PCa-Rezidiv wurden nach Diagnostik mittels Cholin-Positronenemissionstomographie/Computertomographie einer Salvage-LND unterzogen; 46/93 Patienten wurden ausschließlich operiert, 47/93 Patienten erhielten zusätzlich eine ART. Im Fall einer PSA-(prostataspezifisches-Antigen)-Progression wurde durch bildgebende Verfahren das nächste Rezidiv innerhalb oder außerhalb der behandelten Region (TR) diagnostiziert. Der mittlere Beobachtungszeitraum lag bei 3,2 Jahren.


Die Anzahl der Lymphknotenmetastasen war in den zwei Gruppen gleichverteilt. Eine zusätzliche ART bewirkte ein verzögertes Auftreten von neuen Metastasen in der TR (metastasenfreies 5-Jahres-Überleben 70,7 %) im Vergleich zur alleinigen Salvage-LND (metastasenfreies 5-Jahres-Überleben 26,3 %; p < 0,0001). Der Zeitpunkt bis zur Diagnose von Metastasen außerhalb der TR war in beiden Behandlungsarmen nicht signifikant unterschiedlich (27 Monate versus 29,6 Monate; p = 0,359). Unabhängig von der Lokalisation der neuen Metastasen lag das metastasenfreie 5-Jahres-Überleben bei Patienten mit einer Kombinationstherapie bei 34,3 %, bei Patienten mit alleiniger Operation hingegen bei 15,4 % (p = 0,0122). Die zusätzliche Strahlentherapie verursachte, verglichen mit einer alleinigen Operation, keinen signifikanten Unterschied bezüglich der PSA-Wert-Reduktion am Ende des Beobachtungszeitraums.


Eine zusätzliche ART bewirkt eine stabile lokale Tumorkontrolle in der behandelten Region und resultiert in einem signifikant verlängerten metastasenfreien Überleben verglichen mit einer alleinigen Salvage-LND beim nodalen Prostatakarzinomrezidiv.


Prostatakarzinomrezidiv Salvage-Lymphadenektomie Adjuvante Strahlentherapie Lymphknotenmetastasen Salvage-Radiotherapie 


Compliance with ethical guidelines

Conflict of interest

H.C. Rischke, W. Schultze-Seemann, G. Wieser, M. Krönig, V. Drendel, P. Stegmaier, T. Krauss, K. Henne, N. Volegova-Neher, D. Schlager, S. Kirste, A.-L. Grosu, and C.A. Jilg state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Supplementary material

66_2014_763_MOESM1_ESM.docx (112 kb)
(DOCX 113 kb)
66_2014_763_MOESM2_ESM.pdf (779 kb)
(PDF 780 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Hans Christian Rischke
    • 1
    • 2
  • Wolfgang Schultze-Seemann
    • 5
  • Gesche Wieser
    • 2
  • Malte Krönig
    • 5
  • Vanessa Drendel
    • 4
  • Petra Stegmaier
    • 1
  • Tobias Krauss
    • 3
  • Karl Henne
    • 1
  • Natalia Volegova-Neher
    • 1
  • Daniel Schlager
    • 5
  • Simon Kirste
    • 3
  • Anca-Ligia Grosu
    • 1
  • Cordula Annette Jilg
    • 5
    Email author
  1. 1.Department of Radiation OncologyUniversity of FreiburgFreiburgGermany
  2. 2.Department of Nuclear MedicineUniversity of FreiburgFreiburgGermany
  3. 3.Department of RadiologyUniversity of FreiburgFreiburgGermany
  4. 4.Department of PathologyUniversity of FreiburgFreiburgGermany
  5. 5.Department of UrologyUniversity of FreiburgFreiburgGermany

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