nach oben

Erschienen in:

01.04.2015 | Original article

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

verfasst von: Dr. med. Hans Christian Rischke, Prof. Dr. med. Wolfgang Schultze-Seemann, Dr. med. Gesche Wieser, Dr. med. Malte Krönig, Dr. med. Vanessa Drendel, Dr. med. Petra Stegmaier, Dr. med. Tobias Krauss, Dr. med. Karl Henne, Dr. med. Natalia Volegova-Neher, Dr. med. Daniel Schlager, Dr. med. Simon Kirste, Prof. Dr. med. Anca-Ligia Grosu, Cordula Annette Jilg

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 4/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Nur mit Berechtigung zugänglich

Benson RC (1993) Total androgen blockade: the United States experience. Eur Urol 24:72–76PubMed

Bolla M, Van Poppel H, Tombal B et al (2012) Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet 380:2018–2027CrossRefPubMed

Bottke D, Bartkowiak D, Schrader M et al (2012) Radiotherapy after radical prostatectomy: immediate or early delayed? Strahlenther Onkol 188:1096–1101CrossRefPubMed

Briganti A, Joniau S, Gandaglia G et al (2013) Patterns and predictors of early biochemical recurrence after radical prostatectomy and adjuvant radiation therapy in men with pT3N0 prostate cancer: implications for multimodal therapies. Int J Radiat Oncol Biol Phys 87:960–967CrossRefPubMed

Casamassima F, Masi L, Menichelli C et al (2011) Efficacy of eradicative radiotherapy for limited nodal metastases detected with choline PET scan in prostate cancer patients. Tumori 97:49–55PubMed

Coleman CN, Beard CJ, Kantoff PW et al (1994) Rate of relapse following treatment for localized prostate cancer: a critical analysis of retrospective reports. Int J Radiat Oncol Biol Phys 28:303–313CrossRefPubMed

Ctcaev4.0 N (2009) National Cancer Institute common terminology criteria for adverse events v4.0 NCI, NIH, DHHS. NIH publication # 09-7473

Da Pozzo LF, Cozzarini C, Briganti A et al (2009) Long-term follow-up of patients with prostate cancer and nodal metastases treated by pelvic lymphadenectomy and radical prostatectomy: the positive impact of adjuvant radiotherapy. Eur Urol 55:1003–1011CrossRefPubMed

Fiorino C, Alongi F, Perna L et al (2009) Dose-volume relationships for acute bowel toxicity in patients treated with pelvic nodal irradiation for prostate cancer. Int J Radiat Oncol Biol Phys 75:29–35CrossRefPubMed

10.

Guckenberger M, Lawrenz I, Flentje M (2014) Moderately hypofractionated radiotherapy for localized prostate cancer: long-term outcome using IMRT and volumetric IGRT. Strahlenther Onkol 190:48–53CrossRefPubMed

11.

Guerrero Urbano T, Khoo V, Staffurth J et al (2010) Intensity-modulated radiotherapy allows escalation of the radiation dose to the pelvic lymph nodes in patients with locally advanced prostate cancer: preliminary results of a phase I dose escalation study. Clin Oncol (R Coll Radiol) 22:236–244CrossRef

12.

Han M, Partin AW, Zahurak M (2003) Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 169:517–523CrossRefPubMed

13.

Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65:124–137CrossRefPubMed

14.

Heidenreich A, Bastian PJ, Bellmunt J et al (2014) EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 65:467–479CrossRefPubMed

15.

Higano CS (2003) Side effects of androgen deprivation therapy: monitoring and minimizing toxicity. Urology 61:32–38CrossRefPubMed

16.

Jereczek-Fossa BA, Beltramo G, Fariselli L et al (2012) Robotic image-guided stereotactic radiotherapy, for isolated recurrent primary, lymph node or metastatic prostate cancer. Int J Radiat Oncol Biol Phys 82:889–897CrossRefPubMed

17.

Jilg CA, Rischke HC, Schultze-Seemann W (2012) Salvage lymph node dissection with adjuvant radiotherapy for choline-PET-CT positive lymph nodes in patients with nodal recurrence of prostate cancer. J Urol 2012 Dec;188(6):2190–2197. doi:10.1016/j. juro.2012.08.041. (Epub 2012 Oct 18)

18.

Jilg CA, Leifert A, Schnell D et al (2014) Toxicity and quality of life after choline-PET/CT directed salvage lymph node dissection and adjuvant radiotherapy in nodal recurrent prostate cancer. Radiat Oncol 9:178

19.

Jilg CA, Schultze-Seemann W, Drendel V et al (2014) Detection of lymph node metastasis in patients with nodal prostate cancer relapse using F/C-choline positron emission tomography/computerized tomography: influence of size of nodal tumor infiltration and accuracy related to lymph node regions. J Urol 2014 Feb 8. pii: S0022-5347(14)00119-0. doi:10.1016/j.juro.2013.12.054. (Epub ahead of print)

20.

Lawton CA, Michalski J, El-Naqa I et al (2009) RTOG GU radiation oncology specialists reach consensus on pelvic lymph node volumes for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 74:383–387CrossRefPubMedCentralPubMed

21.

Leibowitz-Amit R, Templeton AJ, Omlin A et al (2014) Clinical variables associated with PSA response to abiraterone acetate in patients with metastatic castration-resistant prostate cancer. Ann Oncol 25:657–662CrossRefPubMed

22.

Lohm G, Lutcke J, Jamil B 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 190:727–731CrossRefPubMed

23.

Lu-Yao GL, Yao SL (1997) Population-based study of long-term survival in patients with clinically localised prostate cancer. Lancet 349:906–910CrossRefPubMed

24.

Martini T, Mayr R, Trenti E et al (2012) The role of C-choline-PET/CT-guided secondary lymphadenectomy in patients with PSA failure after radical prostatectomy: lessons learned from eight cases. Adv Urol 2012:601572

25.

Millar J, Boyd R, Sutherland J (2008) An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions: in regard to Lawton et al. (Int J Radiat Oncol Biol Phys 2007;69:646–655.). Int J Radiat Oncol Biol Phys 71:316 (author reply 316)

26.

Pasquier D, Ballereau C (2008) Adjuvant and salvage radiotherapy after prostatectomy for prostate cancer: a literature review. Int J Radiat Oncol Biol Phys 72:972–979CrossRefPubMed

27.

Picchio M, Briganti A, Fanti S et al (2011) The role of choline positron emission tomography/computed tomography in the management of patients with prostate-specific antigen progression after radical treatment of prostate cancer. Eur Urol 59:51–60CrossRefPubMed

28.

Picchio M, Berardi G, Fodor A et al (2014) C-choline PET/CT as a guide to radiation treatment planning of lymph-node relapses in prostate cancer patients. Eur J Nucl Med Mol Imaging 41:1270–1279

29.

Rigatti P, Suardi N, Briganti A (2011) Pelvic/retroperitoneal salvage lymph node dissection for patients treated with radical prostatectomy with biochemical recurrence and nodal recurrence detected by [11C]choline positron emission tomography/computed tomography. Eur Urol 60:935–943CrossRefPubMed

30.

Rinnab L, Mottaghy FM, Blumstein NM (2007) Evaluation of [11C]-choline positron-emission/computed tomography in patients with increasing prostate-specific antigen levels after primary treatment for prostate cancer. BJU Int 100:786–793CrossRefPubMed

31.

Rischke HC, Knippen S, Kirste S et al (2012) Treatment of recurrent prostate cancer following radical prostatectomy: the radiation-oncologists point of view. Q J Nucl Med Mol Imaging 56:409–420PubMed

32.

Sanpaolo P, Barbieri V, Genovesi D (2014) Biologically effective dose and definitive radiation treatment for localized prostate cancer: treatment gaps do affect the risk of biochemical failure. Strahlenther Onkol 190:732–738CrossRefPubMed

33.

Schiller K, Petrucci A, Geinitz H et al (2014) Impact of different setup approaches in image-guided radiotherapy as primary treatment for prostate cancer: a study of 2940 setup deviations in 980 MVCTs. Strahlenther Onkol 190:722–726CrossRefPubMed

34.

Suardi N, Gandaglia G, Gallina A et al (2014) Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: results of a single-institution series with a minimum follow-up of 5 years. Eur Urol 2014 Feb 18. pii: S0302-2838(14)00130-4. doi:10.1016/j.eururo.2014.02.011. (Epub ahead of print)

35.

Thompson IM, Tangen CM, Paradelo J et al (2009) Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 181:956–962CrossRefPubMedCentralPubMed

36.

Wiegel T, Bartkowiak D, Bottke D et al (2014) Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/AUO AP 09/95 trial. Eur Urol. 2014 Mar 21. pii: S0302-2838(14)00247-4. doi:10.1016/j.eururo.2014.03.011. (Epub ahead of print)

Titel: Adjuvant radiotherapy after salvage lymph node dissection because of nodal relapse of prostate cancer versus salvage lymph node dissection only
verfasst von: Dr. med. Hans Christian Rischke
Prof. Dr. med. Wolfgang Schultze-Seemann
Dr. med. Gesche Wieser
Dr. med. Malte Krönig
Dr. med. Vanessa Drendel
Dr. med. Petra Stegmaier
Dr. med. Tobias Krauss
Dr. med. Karl Henne
Dr. med. Natalia Volegova-Neher
Dr. med. Daniel Schlager
Dr. med. Simon Kirste
Prof. Dr. med. Anca-Ligia Grosu
Cordula Annette Jilg
Publikationsdatum: 01.04.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 4/2015
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-014-0763-5

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

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