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Whole pelvis radiotherapy for pathological node-positive prostate cancer

Oncological outcome and prognostic factors

Bestrahlung des gesamten Beckens beim nodal metastasierten Prostatakarzinom

Onkologisches Outcome und prognostische Faktoren

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Abstract

Purpose

The goal of this work was to investigate the oncological outcome of whole pelvis radiotherapy (wpRT) in pathologic pelvic lymph node-positive (pN1) prostate cancer (PCa), evaluate the location of relapse, and identify potential prognostic factors.

Patients and methods

All patients undergoing pelvic lymph node dissection (PLND) since the year 2000 at a single tertiary care center were evaluated. A total of 154 patients with pN1 PCa were treated with wpRT (39 in an adjuvant setting) and 2–3 years of androgen deprivation therapy (ADT). Kaplan–Meier analysis was performed to estimate biochemical recurrence-free survival (bRFS), clinical progression-free survival (cPFS), and prostate cancer-specific survival (CSS). Uni- and multivariate regression analyses were performed to identify prognostic factors.

Results

Estimated bRFS was 67%, cPFS was 71%, and CSS was 96% at 5 years. Median follow-up was 55 months (interquartile range 25–87). Multivariate analysis identified having only 1 positive lymph node, a shorter time between diagnosis and PLND, and older age as independent favorable prognostic factors for biochemical and clinical recurrence. The number of positive lymph nodes was prognostic for CSS (hazard ratio [HR] 1.34, 95% confidence interval 1.17–1.54) and OS (HR 1.22, 95% confidence interval 1.10–1.36). Bone metastases were the most frequent location of PCa relapse (n = 32, 64%).

Conclusions

Patients with pN1 PCa treated with wpRT and 2–3 years ADT have an encouraging 5‑year CSS. Understaging of the disease extent may be the most important enemy in definitive pN1 PCa treatment.

Zusammenfassung

Ziel

Das Ziel dieser Studie war es, das onkologische Outcome der Bestrahlung des gesamten Beckens (wpRT) beim histologisch gesicherten nodal metastasierten Prostatakarzinom zu untersuchen, die Lokalisation eines eventuellen Rezidivs zu charakterisieren und mögliche prognostische Faktoren zu identifizieren.

Methoden

Alle Patienten, bei denen seit dem Jahr 2000 eine pelvine Lymphknotendissektion (PLND) durchgeführt worden war, wurden eingeschlossen. Insgesamt 154 Patienten mit pN1-Prostatakarzinomen wurden mit wpRT (davon 39 im adjuvanten Setting) und Androgendeprivation (ADT) behandelt. Zur Bestimmung des biochemischen rezidivfreien Intervalls (bRFS), des klinischen progressionsfreien Überlebens (cPFS) und des Prostatakarzinom-spezifischen Gesamtüberlebens (CSS) wurden Kaplan-Meier-Analysen durchgeführt. Mögliche prognostische Faktoren wurden mittels uni- und multivariater Regressionsanalyse identifiziert.

Ergebnisse

Das bRFS wurde für ein Beobachtungsintervall von 5 Jahren auf 67 %, das cPFS auf 71 % und die CSS auf 96 % geschätzt. Das mediane Follow-up betrug 55 Monate (IQR 25–87). Nur 1 positiver Lymphknoten, eine kurze Zeit zwischen Diagnose und PLND und höheres Alter waren in der multivariaten Analyse günstige prognostische Faktoren bezüglich eines biochemischen oder klinischen Rezidivs. Die Anzahl der positiven Lymphknoten war ein prognostischer Faktor für das CSS (HR 1,34 [1,17–1,54]) und das Gesamtüberleben (HR 1,22 [1,10–1,36]). Das Achsenskelett war die häufigste Lokalisation eines PCa-Rezidivs (n = 32, 64 %).

Schlussfolgerung

Das 5‑Jahres-CSS bei Patienten mit nodal metastasiertem Prostatakarzinom, die mit wpRT und 2–3 Jahren ADT behandelt werden, ist erfreulich hoch. Die Unterschätzung des Ausmaßes der Erkrankung könnte der wesentlichste adverse Faktor bezüglich einer guten Langzeitprognose bei der Behandlung von Patienten mit nodal metastasiertem Prostatakarzinom darstellen.

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Authors and Affiliations

  1. Department of Urology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Filip Poelaert MD, Karel Decaestecker MD PhD, Tom Claeys MD, Bert Dhondt MD & Nicolaas Lumen MD PhD

  2. Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium

    Valérie Fonteyne MD PhD & Piet Ost MD PhD

  3. Department of Urology, AZ Nikolaas, Sint-Niklaas, Belgium

    Bart De Troyer MD

  4. Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium

    Gert De Meerleer MD PhD

  5. Department of Radiology, Ghent University Hospital, Ghent, Belgium

    Pieter De Visschere MD PhD

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  1. Filip Poelaert MD
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  2. Valérie Fonteyne MD PhD
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Corresponding author

Correspondence to Filip Poelaert MD.

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Conflict of interest

F. Poelaert, V. Fonteyne, P. Ost, B. De Troyer, K. Decaestecker, G. De Meerleer, P. De Visschere, T. Claeys, B. Dhondt, and N. Lumen declare that they have no competing interests.

Ethical standards

This retrospective study was approved by the local ethics committee (UZG2011/495).

Caption Electronic Supplementary Material

Table 1 Univariate Cox regression analysis for outcome

66_2016_1094_MOESM2_ESM.doc

Table 2 Multivariate Cox regression analysis for outcome, with different steps to identify independent prognostic factors

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Poelaert, F., Fonteyne, V., Ost, P. et al. Whole pelvis radiotherapy for pathological node-positive prostate cancer. Strahlenther Onkol 193, 444–451 (2017). https://doi.org/10.1007/s00066-016-1094-5

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