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Dose-escalated pelvic radiotherapy for prostate cancer in definitive or postoperative setting

  • Radiotherapy
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Abstract

Purpose

Given the absence of standardized planning approach for clinically node-positive (cN1) prostate cancer (PCa), we collected data about the use of prophylactic pelvic irradiation and nodal boost. The aim of the present series is to retrospectively assess clinical outcomes after this approach to compare different multimodal treatment strategies in this scenario.

Methods

Data from clinical records of patients affected by cN1 PCa and treated in six different Italian institutes with prophylactic pelvic irradiation and boost on pathologic pelvic lymph nodes detected with CT, MRI or choline PET/CT were retrospectively reviewed and collected. Clinical outcomes in terms of overall survival (OS) and biochemical relapse-free survival (b-RFS) were explored. The correlation between outcomes and baseline features (International Society of Urological Pathology-ISUP pattern, total dose to positive pelvic nodes ≤ / > 60 Gy, sequential or simultaneous integrated boost (SIB) administration and definitive vs postoperative treatment) was explored.

Results

ISUP pattern < 2 was a significant predictor of improved b-RFS (HR = 0.3, 95% CI 0.1220–0.7647, P = 0.0113), while total dose < 60 Gy to positive pelvic nodes was associated with worse b-RFS (HR = 3.59, 95% CI 1.3245–9.741, P = 0.01). Conversely, treatment setting (postoperative vs definitive) and treatment delivery technique (SIB vs sequential boost) were not associated with significant differences in terms of b-RFS (HR = 0.85, 95% CI 0.338–2.169, P = 0.743, and HR = 2.39, 95% CI 0.93–6.111, P = 0.067, respectively).

Conclusion

Results from the current analysis are in keeping with data from literature showing that pelvic irradiation and boost on positive nodes are effective approaches. Upfront surgical approach was not associated with better clinical outcomes.

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Authors and Affiliations

  1. Radiation Oncology Unit, University of Florence, Viale Morgagni 85, 50134, Florence, Italy

    Giulio Francolini & Beatrice Detti

  2. CyberKnife Center, Istituto Fiorentino di Cura ed Assistenza, Florence, Italy

    Giulio Francolini & Vanessa Di Cataldo

  3. Department of Biomedical, Experimental, and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy

    Giulia Stocchi, Matteo Mariotti, Viola Salvestrini, Pietro Garlatti, Isacco Desideri & Lorenzo Livi

  4. Radiotherapy Unit, University Hospital of Modena, Modena, Italy

    Alessio Bruni

  5. Department of Radiation Oncology, Brescia University, Brescia, Italy

    Luca Triggiani & Andrea Emanuele Guerini

  6. Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy

    Rosario Mazzola & Francesco Cuccia

  7. Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy

    Simona Borghesi

  8. Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy

    Gianluca Ingrosso, Rita Bellavita & Cynthia Aristei

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  1. Giulio Francolini
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  2. Giulia Stocchi
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Correspondence to Giulio Francolini.

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Ethical approval was waived by the local Ethics Committees in view of the retrospective nature of the study and all the procedures being performed were part of routine care. The study was performed according to the Declaration of Helsinki, and written informed consent was obtained for all patients.

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All patients gave consent for the use of their anonymized data for research and educational purposes. All procedures were performed in accordance with ethical standards of institutional ethical committee.

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Francolini, G., Stocchi, G., Detti, B. et al. Dose-escalated pelvic radiotherapy for prostate cancer in definitive or postoperative setting. Radiol med 127, 206–213 (2022). https://doi.org/10.1007/s11547-021-01435-8

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