Radiotherapy for pelvic nodal recurrences after radical prostatectomy: patient selection in clinical practice
Posted on 2020-06-02 - 04:08
Abstract Aim There is no general consensus on the optimal treatment for prostate cancer (PC) patients with intrapelvic nodal oligorecurrences after radical prostatectomy. Besides androgen deprivation therapy (ADT) as standard of care, both elective nodal radiotherapy (ENRT) and stereotactic body radiotherapy (SBRT) as well as salvage lymph node dissection (sLND) are common treatment options. The aim of our study was to assess decision making and practice patterns for salvage radiotherapy (RT) in this setting. Methods Treatment recommendations from 14 Swiss radiation oncology centers were collected and converted into decision trees. An iterative process using the objective consensus methodology was applied to assess differences and consensus. Results PSMA PET/CT was recommended by 93% of the centers as restaging modality. For unfit patients defined by age, comorbidities or low performance status, androgen deprivation therapy (ADT) alone was recommended by more than 70%. For fit patients with unfavorable tumor characteristics such as short prostate-specific antigen (PSA) doubling time or initial high-risk disease, the majority of the centers (57–71%) recommended ENRT + ADT for 1–4 lesions. For fit patients with favorable tumor characteristics, there were low levels of consensus and a wide variety of recommendations. For 1–4 nodal lesions, focal SBRT was offered by 64% of the centers, most commonly as a 5-fraction course. Conclusions As an alternative to ADT, ENRT or SBRT for pelvic nodal oligorecurrences of PC are commonly offered to selected patients, with large treatment variations between centers. The exact number of lymph nodes had a major impact on treatment selection.
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Panje, Cedric; Zilli, Thomas; Dal Pra, Alan; Arnold, Winfried; Brouwer, Kathrin; Garcia Schüler, Helena I.; et al. (2019). Radiotherapy for pelvic nodal recurrences after radical prostatectomy: patient selection in clinical practice. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.4701719.v2
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AUTHORS (15)
CP
Cedric Panje
TZ
Thomas Zilli
AD
Alan Dal Pra
WA
Winfried Arnold
KB
Kathrin Brouwer
HG
Helena I. Garcia Schüler
SG
Silvia Gomez
FH
Fernanda Herrera
KK
Kaouthar Khanfir
AP
Alexandros Papachristofilou
GP
Gianfranco Pesce
CR
Christiane Reuter
HV
Hansjörg Vees
DZ
Daniel Zwahlen
PP
Paul Martin Putora