Oligorecurrent prostate cancer: nodal radiotherapy shows reduced recurrences but higher toxicity

  • De Bleser E
  • Eur Urol
  • 19 Jul 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with hormone-sensitive nodal oligorecurrent prostate cancer, elective nodal radiotherapy (ENRT) reduces nodal recurrences but is associated with higher toxicity vs stereotactic body radiotherapy (SBRT).

Why this matters

  • Both strategies as potential treatment option in these patients are endorsed in expert consensus statements.

Study design

  • Multicenter study of 506 patients with hormone-sensitive nodal oligorecurrent prostate cancer who received SBRT (n=309) or ENRT (n=197) after local treatment with radical prostatectomy, radiotherapy, or both.
  • Funding: National Institute for Health Research.

Key results

  • Median follow-up was 36 months.
  • 3-year metastasis-free survival (MFS) was significantly higher with ENRT vs SBRT (77% vs 68%; P=.01).
  • ENRT significantly prolonged adjusted MFS in patients with 1 node at recurrence (HR, 0.50; P=.009), but not in those with >1 lymph node (HR, 0.92; P=.8).
  • SBRT was associated with significantly higher incidences of progression vs ENRT (177 vs 74 patients; P<.001 style="list-style-type:circle;">
  • local progression (50 vs 9 patients; P<.001>
  • lymph node progression (P<.001 and>
  • pelvic lymph node progression (P<.001>
  • ENRT was associated with higher incidence of:
    • grade ≥3 toxicity (5 vs 0; P=.009);
    • early toxicity (12 vs 3; P=.002); and
    • late toxicity (31 vs 16; P<.001>
  • Limitations

    • Retrospective design.

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