High-risk prostate cancer: no increased toxicity with pelvic lymph node irradiation

  • Parry MG & al.
  • J Clin Oncol
  • 4 Jun 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with high-risk localized or locally advanced prostate cancer, including pelvic lymph node (PLN) in radiation field does not increase the risk for gastrointestinal or genitourinary toxicity vs prostate-only intensity-modulated radiation therapy (IMRT) at 3 years.

Why this matters

  • UK NICE guidelines recommend PLN irradiation in high-risk patients; extending the treatment field to include the PLN can prevent relapse without increasing gastrointestinal or genitourinary toxicity.

Study design

  • 3845 patients with high-risk localized or locally advanced prostate cancer treated with IMRT.
  • Funding: None disclosed.

Key results

  • Median follow-up was 2.7 years.
  • 20% of patients received PLN irradiation.
  • In patients who underwent prostate and PLN-IMRT vs prostate-only IMRT:
    • 3-year cumulative incidence of gastrointestinal complications was 14% for both.
    • 3-year cumulative incidence of genitourinary toxicity was 9% vs 8%.
    • 4.9 vs 5.1 gastrointestinal complications per 100 person-years and 3.2 vs 2.7 genitourinary complications per 100 person-years were observed.
  • Men with ≥1 comorbidity had higher risk for genitourinary toxicity vs those without (subdistribution HR, 1.39; P=.01).
  • Patients in the highest vs lowest quintile of socioeconomic deprivation had lower gastrointestinal toxicity (subdistribution HR, 0.68; P=.01).

Limitations

  • Retrospective design.
  • Short follow-up time.

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