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Postoperative elective pelvic nodal irradiation compared to prostate bed irradiation in locally advanced prostate cancer - a retrospective analysis of dose-escalated patients.


ABSTRACT: BACKGROUND:It is uncertain if whole-pelvic irradiation (WPRT) in addition to dose-escalated prostate bed irradiation (PBRT) improves biochemical progression-free survival (bPFS) after prostatectomy for locally advanced tumors. This study was initiated to analyze if WPRT is associated with bPFS in a patient cohort with dose-escalated (> 70 Gy) PBRT. METHODS:Patients with locally advanced, node-negative prostate carcinoma who had PBRT with or without WPRT after prostatectomy between 2009 and 2017 were retrospectively analyzed. A simultaneous integrated boost with equivalent-doses-in-2-Gy-fractions (EQD-2) of 79.29 Gy or 71.43 Gy to the prostate bed was applied in patients with margin-positive (or detectable) and margin-negative/undetectable tumors, respectively. WPRT (44 Gy) was offered to patients at an increased risk of lymph node metastases. RESULTS:Forty-three patients with PBRT/WPRT and 77 with PBRT-only were identified. Baseline imbalances included shorter surgery-radiotherapy intervals (S-RT-Intervals) and fewer resected lymph nodes in the WPRT group. WPRT was significantly associated with better bPFS in univariate (p = 0.032) and multivariate models (HR = 0.484, p = 0.015). Subgroup analysis indicated a benefit of WPRT (p = 0.029) in patients treated with rising PSA values who mostly had negative margins (74.1%); WPRT was not associated with a longer bPFS in the postoperative setting with almost exclusively positive margins (96.8%). CONCLUSION:We observed a longer bPFS after WPRT compared to PBRT in patients with locally advanced prostate carcinoma who underwent dose-escalated radiotherapy. In subset analyses, the association was only observed in patients with rising PSA values but not in patients with non-salvage postoperative radiotherapy for positive margins.

SUBMITTER: Link C 

PROVIDER: S-EPMC6554899 | biostudies-other | 2019 Jun

REPOSITORIES: biostudies-other

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Postoperative elective pelvic nodal irradiation compared to prostate bed irradiation in locally advanced prostate cancer - a retrospective analysis of dose-escalated patients.

Link Carola C   Honeck Patrick P   Makabe Akiko A   Giordano Frank Anton FA   Bolenz Christian C   Schaefer Joerg J   Bohrer Markus M   Lohr Frank F   Wenz Frederik F   Buergy Daniel D  

Radiation oncology (London, England) 20190607 1


<h4>Background</h4>It is uncertain if whole-pelvic irradiation (WPRT) in addition to dose-escalated prostate bed irradiation (PBRT) improves biochemical progression-free survival (bPFS) after prostatectomy for locally advanced tumors. This study was initiated to analyze if WPRT is associated with bPFS in a patient cohort with dose-escalated (> 70 Gy) PBRT.<h4>Methods</h4>Patients with locally advanced, node-negative prostate carcinoma who had PBRT with or without WPRT after prostatectomy between  ...[more]

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