Abstract
Purpose
To compare the impact of elective whole pelvic radiotherapy (WPRT) versus prostate bed-only radiotherapy (PBRT) on biochemical relapse-free survival (bRFS) in prostate cancer patients treated with salvage radiotherapy following radical prostatectomy (RP).
Patients and methods
In our database, 163 lymph node-negative prostate cancer patients who had undergone salvage radiotherapy (SRT) for biochemical relapse after RP between September 2004 and April 2012 were identified. PBRT was administered to 134 patients (the PBRT group), while the remaining 29 patients (the WPRT group) received WPRT.
Results
Median follow-up was 57 months (range 18–122 months). In the propensity score-matched cohort, the 4-year bRFS of the WPRT group was significantly higher compared to the PBRT group (63.1 vs. 43.4 %, p = 0.034). Subgroup analysis showed that the bRFS of patients who had two or more risk factors (seminal vesicle invasion, Roach score for lymph node invasion ≥ 45 %, and number of harvested lymph nodes ≤ 5) and were treated with WPRT was significantly improved compared to those who received PBRT (hazard ratio, HR 0.33; 95 % confidence interval, CI 0.13–0.83; p = 0.018).
Conclusion
Elective WPRT for SRT may improve bRFS in patients with unfavorable risk factors. These results need to be confirmed by a prospective randomized trial.
Zusammenfassung
Ziel
Vergleich der Auswirkungen der gezielten Beckenstrahlentherapie (WPRT) gegenüber der Prostatastrahlentherapie (PBRT) hinsichtlich des biochemischen rezidivfreien Überlebens (bRFS) bei Prostatakarzinompatienten, die nach radikaler Prostatektomie (RP) mit einer Salvage-Strahlentherapie (SRT) behandelt wurden.
Patienten und Methoden
Aus unserer Datenbank wurden 163 lymphknotennegative Patienten mit Prostatakrebs identifiziert, die sich nach RP zwischen September 2004 und April 2012 wegen einem biochemischen Rückfall einer rettenden SRT unterzogen hatten. PBRT wurde 134 Patienten verabreicht (PBRT-Gruppe), während die übrigen 29 Patienten eine WPRT erhielten (WPRT-Gruppe).
Ergebnisse
Die mediane Nachbeobachtungszeit betrug 57 Monate (Spanne: 18–122 Monate). In der auf den Propensity-Score abgestimmten Kohorte war das 4-Jahres-bRFS der WPRT-Gruppe im Vergleich zur PBRT-Gruppe signifikant höher (63,1 vs. 43,4 %; p = 0,034). Eine Untergruppenanalyse zeigte, dass sich das bRFS der Patienten, die zwei oder mehr Risikofaktoren hatten (Samenblasenbefall, Roach-Score für Lymphknotenbefall ≥ 45 % und Zahl der entfernten Lymphknoten ≤ 5) und mit WPRT behandelt wurden, im Vergleich zu diejenigen, die PBRT erhalten hatten, deutlich verbessert (Hazard-Ratio 0,33; 95 %-Konfidenzintervall 0,13–0,83; p = 0,018).
Fazit
Eine gezielte WPRT-Strahlentherapie kann das bRFS bei Patienten mit ungünstigen Risikofaktorenverbessern. Diese Ergebnisse müssen in einer prospektiven randomisierten Studie bestätigt werden.
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References
Kattan MW, Wheeler TM, Scardino PT (1999) Postoperative nomogram for disease recurrence after radical prostatectomy for prostate cancer. J Clin Oncol 17:1499–1507
Mullins JK, Feng Z, Trock BJ, Epstein JI, Walsh PC et al (2012) The impact of anatomical radical retropubic prostatectomy on cancer control: the 30-year anniversary. J Urol 188:2219–2224
Fortin I, Carrier JF, Beauchemin MC, Beliveau-Nadeau D, Delouya G et al (2014) Using fiducial markers in the prostate bed in postprostatectomy external beam radiation therapy improves accuracy over surgical clips. Strahlenther Onkol 190:467–471
Bottke D, Bartkowiak D, Schrader M, Wiegel T (2012) Radiotherapy after radical prostatectomy: immediate or early delayed? Strahlenther Onkol 188:1096–1101
Trock BJ, Han M, Freedland SJ, Humphreys EB, DeWeese TL et al (2008) Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 299:2760–2769
Cotter SE, Chen MH, Moul JW, Lee WR, Koontz BF et al (2011) Salvage radiation in men after prostate-specific antigen failure and the risk of death. Cancer 117:3925–3932
Stephenson AJ, Shariat SF, Zelefsky MJ, Kattan MW, Butler EB et al (2004) Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA 291:1325–1332
Lohm G, Lutcke J, Jamil B, Hocht S, Neumann K et al (2014) Salvage radiotherapy in patients with prostate cancer and biochemical relapse after radical prostatectomy: long-term follow-up of a single-center survey. Strahlenther Onkol 190:727–731
Langenhuijsen JF, Donker R, McColl GM, Kiemeney LA, Witjes JA et al (2013) Postprostatectomy ultrasound-guided transrectal implantation of gold markers for external beam radiotherapy. Technique and complications rate. Strahlenther Onkol 189:476–481
Evangelista L, Guttilla A, Zattoni F, Muzzio PC, Zattoni F (2013) Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: a systematic literature review and meta-analysis. Eur Urol 63:1040–1048
Thoeny HC, Forstner R, De Keyzer F (2012) Genitourinary applications of diffusion-weighted MR imaging in the pelvis. Radiology 263:326–342
Paparo F, Piccardo A, Bacigalupo L, Romagnoli A, Piccazzo R et al (2015) Value of bimodal F-choline-PET/MRI and trimodal F-choline-PET/MRI/TRUS for the assessment of prostate cancer recurrence after radiation therapy and radical prostatectomy. Abdom Imaging [Epub ahead of print]
Kitajima K, Murphy RC, Nathan MA, Froemming AT, Hagen CE et al (2014) Detection of recurrent prostate cancer after radical prostatectomy: comparison of 11C-choline PET/CT with pelvic multiparametric MR imaging with endorectal coil. J Nucl Med 55:223–232
Abdollah F, Sun M, Thuret R, Budaus L, Jeldres C et al (2010) Decreasing rate and extent of lymph node staging in patients undergoing radical prostatectomy may undermine the rate of diagnosis of lymph node metastases in prostate cancer. Eur Urol 58:882–892
Feifer AH, Elkin EB, Lowrance WT, Denton B, Jacks L et al (2011) Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy. Cancer 117:3933–3942
Moghanaki D, Koontz BF, Karlin JD, Wan W, Mukhopadhay N et al (2013) Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy. Cancer 119:52–60
Spiotto MT, Hancock SL, King CR (2007) Radiotherapy after prostatectomy: improved biochemical relapse-free survival with whole pelvic compared with prostate bed only for high-risk patients. Int J Radiat Oncol Biol Phys 69:54–61
Kim BS, Lashkari A, Vongtama R, Lee SP, Parker RG (2004) Effect of pelvic lymph node irradiation in salvage therapy for patients with prostate cancer with a biochemical relapse following radical prostatectomy. Clin Prostate Cancer 3:93–97
King CR (2012) The timing of salvage radiotherapy after radical prostatectomy: a systematic review. Int J Radiat Oncol Biol Phys 84:104–111
Mir MC, Li J, Klink JC, Kattan MW, Klein EA et al (2014) Optimal definition of biochemical recurrence after radical prostatectomy depends on pathologic risk factors: identifying candidates for early salvage therapy. Eur Urol 66:204–210
Briganti A, Karnes RJ, Joniau S, Boorjian SA, Cozzarini C et al (2014) Prediction of outcome following early salvage radiotherapy among patients with biochemical recurrence after radical prostatectomy. Eur Urol 66:479–486
D’Agostino RB Jr, D’Agostino RB Sr (2007) Estimating treatment effects using observational data. JAMA 297:314–316
Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ et al (1997) Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 277:1445–1451
Joo JH, Kim YJ, Kim YS, Choi EK, Kim JH et al (2013) Whole pelvic intensity-modulated radiotherapy for high-risk prostate cancer: a preliminary report. Radiat Oncol J 31:199–205
Roach M 3rd, Marquez C, Yuo HS, Narayan P, Coleman L et al (1994) Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 28:33–37
Medica M, Giglio M, Germinale F, Timossi L, Romagnoli A et al (2001) Roach’s mathematical equations in predicting pathological stage in men with clinically localized prostate cancer. Tumori 87:130–133
Shariat SF, Karakiewicz PI, Suardi N, Kattan MW (2008) Comparison of nomograms with other methods for predicting outcomes in prostate cancer: a critical analysis of the literature. Clin Cancer Res 14:4400–4407
Nguyen PL, Chen MH, Hoffman KE, Katz MS, D’Amico AV (2009) Predicting the risk of pelvic node involvement among men with prostate cancer in the contemporary era. Int J Radiat Oncol Biol Phys 74:104–109
Abdollah F, Cozzarini C, Suardi N, Gallina A, Capitanio U et al (2012) Indications for pelvic nodal treatment in prostate cancer should change. Validation of the Roach formula in a large extended nodal dissection series. Int J Radiat Oncol Biol Phys 83:624–629
Rahman S, Cosmatos H, Dave G, Williams S, Tome M (2012) Predicting pelvic lymph node involvement in current-era prostate cancer. Int J Radiat Oncol Biol Phys 82:906–910
Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S et al (2014) EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65:124–137
Heidenreich A, Varga Z, Von Knobloch R (2002) Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 167:1681–1686
Stone NN, Stock RG, Unger P (1997) Laparoscopic pelvic lymph node dissection for prostate cancer: comparison of the extended and modified techniques. J Urol 158:1891–1894
Bader P, Burkhard FC, Markwalder R, Studer UE (2002) Is a limited lymph node dissection an adequate staging procedure for prostate cancer? J Urol 168:514–518. (discussion 518)
Joslyn SA, Konety BR (2006) Impact of extent of lymphadenectomy on survival after radical prostatectomy for prostate cancer. Urology 68:121–125
Masterson TA, Bianco FJ Jr, Vickers AJ, DiBlasio CJ, Fearn PA et al (2006) The association between total and positive lymph node counts, and disease progression in clinically localized prostate cancer. J Urol 175:1320–1324. (discussion 1324–1325)
A phase III trial of short term androgen deprivation with pelvic lymph node or prostate bed only radiotherapy (SPPORT) in prostate cancer patients with a rising PSA after radical prostatectomy.http://clinicaltrials.gov/ct2/show/NCT00567580?term=rtog+0534&rank=1. Accessed 2 July 2015
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C. Song, H.-C. Kang, J.-S. Kim,*, K.-Y. Eom, I.A. Kim, J.-B. Chung, S.K. Hong, S.-S. Byun, and S.E. Lee 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.
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Changhoon Song and Hyun-Cheol Kang contributed equally to this work.
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Song, C., Kang, HC., Kim, JS. et al. Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy. Strahlenther Onkol 191, 801–809 (2015). https://doi.org/10.1007/s00066-015-0872-9
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DOI: https://doi.org/10.1007/s00066-015-0872-9