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Fink CA, Wegener D, Sauer LD, Lentz-Hommertgen A, Liermann J, Müller AC, Zips D, Debus J, Herfarth K, Koerber SA. Pelvic Irradiation for Node-Positive Prostate Cancer After Prostatectomy: Long-Term Results of the Prospective PLATIN-4 and PLATIN-5 Trials. Int J Radiat Oncol Biol Phys 2024; 118:1011-1017. [PMID: 37863242 DOI: 10.1016/j.ijrobp.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE After radical prostatectomy (RP), adjuvant or salvage radiation treatment in node-positive prostate cancer is offered to prevent systemic disease. Prospective long-term survival and toxicity data on patients with radiation for nodal disease are still scarce. This study evaluates safety and feasibility of salvage radiation therapy to the pelvic lymph nodes in node-positive prostate cancer after RP. METHODS AND MATERIALS Between 2009 and 2018, 78 patients with lymph node recurrence after RP (PLATIN-4 trial) or after RP and prostate bed radiation therapy (PLATIN-5 trial) were treated with salvage pelvic lymph node radiation therapy with boost to the involved nodes as field abutment (PLATIN-5) and boost to the prostate bed (PLATIN-4). Androgen deprivation therapy was started 2 months before radiation and recommended for 24 months. The primary endpoint was safety and feasibility of the intensity modulated radiation therapy-image guided radiation therapy technique based on the rate of treatment discontinuations and incidence of Common Terminology Criteria for Adverse Events grade 3+ toxicity. Secondary endpoints were progression-free survival and overall survival. RESULTS No treatment discontinuations were reported in either trial. Median overall survival was not reached in PLATIN-4 and was 117 months in PLATIN-5. Median progression-free survival was 66 months in PLATIN-4 and 39 months in PLATIN-5. Late grade 3+ genitourinary and gastrointestinal toxicities were observed in 4% of patients at 24 months of follow-up. CONCLUSIONS Salvage radiation therapy to the prostate bed and pelvic lymphatic drainage combined with long-term androgen deprivation therapy is a curative treatment option for patients with node-positive prostate cancer after RP, with excellent in-field disease control. Pelvic lymph node radiation therapy as field abutment after prostate bed radiation therapy is feasible with long-term survival and no high-grade toxicity.
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Affiliation(s)
- Christoph A Fink
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany.
| | - Daniel Wegener
- Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | - Lukas D Sauer
- University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Adriane Lentz-Hommertgen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | | | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Clinical Cooperation Unit, German Cancer Research Center, Heidelberg, Germany; Heidelberg Ion Beam Therapy Center, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Heidelberg Ion Beam Therapy Center, Heidelberg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Department of Radiation Oncology, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany
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Gelardi F, Briganti A, Pini C, Ninatti G, Gandaglia G, Montorsi F, Chiti A. European guidelines update on PSMA PET/CT for prostate cancer staging-snap back to reality. Eur J Nucl Med Mol Imaging 2023; 50:2572-2575. [PMID: 37261474 DOI: 10.1007/s00259-023-06287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Fabrizia Gelardi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele, Milan, Italy
| | - Cristiano Pini
- Department of Nuclear Medicine, IRCCS San Raffaele, Milan, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Gaia Ninatti
- Department of Nuclear Medicine, IRCCS San Raffaele, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giorgio Gandaglia
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele, Milan, Italy
| | - Arturo Chiti
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Nuclear Medicine, IRCCS San Raffaele, Milan, Italy
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Chopade P, Maitre P, David S, Panigrahi G, Singh P, Phurailatpam R, Murthy V. Common iliac node positive prostate cancer treated with curative radiotherapy: N1 or M1a? Int J Radiat Oncol Biol Phys 2022; 114:711-717. [PMID: 35870708 DOI: 10.1016/j.ijrobp.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Common iliac (CI) nodes are staged as (oligo)metastatic M1a for prostate cancer. It is unclear if outcomes of pelvic node-positive (cN1) differ from CI node-positive (CI-M1a) prostate cancer after curative treatment. Present study compares outcomes in these patients treated with radical whole pelvic radiotherapy and long-term ADT. MATERIALS AND METHODS Patients with node positive adenocarcinoma prostate were identified, either CI-M1a or cN1, from a prospectively maintained database. Over 75% of these patients were staged with Ga68PSMA-PETCT at diagnosis. All patients received long-term ADT and moderately or extremely hypofractionated radiotherapy to the prostate and pelvis including the CI region. At biochemical failure (BCF), restaging was done with Ga68PSMA-PETCT to establish the patterns of failure. CI-M1a cohort was classified as proximal or distal CI nodal location and studied for outcomes. RESULTS Of the 130 patients analyzed, 87 had cN1 and 43 had CI-M1a stage. Median duration of ADT before RT was 7 months and total duration was atleast 24 months. Majority (65%) had Gleason grade group IV-V while 75% had ≥T3 disease. After a median FU of 61 months, BCF in the 2 groups were similar, cN1, 21/87 (24.1%); CI-M1a, 11/43 (25.6%), p=0.86. At BCF, restaging Ga68-PSMA-PET-CT located distant metastases in 20 (63%) of the 32 patients (57% in cN1, and 73% in CI-M1a, p=0.47). Five-year biochemical failure-free survival (cN1; 77.4% and CI-M1a; 70.4%, p=0.43), distant metastasis-free survival (cN1; 86.9% and CI-M1a; 79.4%, p=0.23) and overall survival (cN1 92.6% and CI-M1a 90.1%, p=0.80) were similar in the two groups. Outcomes within CI-M1a were similar for proximal versus distal CI nodal location, 5-year BFFS 73.6% vs 58.6% (p=0.81). CONCLUSION Oligometastatic CI-M1a and cN1 prostate cancer patients showed similar outcomes when treated with curative whole pelvic radiotherapy and long-term ADT. The treatment for these 'oligometastatic' patients should be prospectively evaluated and optimized accordingly.
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Affiliation(s)
- Pradnya Chopade
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Sam David
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Gitanjali Panigrahi
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Pallavi Singh
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Reena Phurailatpam
- Department of Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India.
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