Elective nodal radiotherapy in prostate cancer.

Published on Aug 1, 2021in Lancet Oncology41.316
· DOI :10.1016/S1470-2045(21)00242-4
Gert De Meerleer36
Estimated H-index: 36
(Katholieke Universiteit Leuven),
Charlien Berghen5
Estimated H-index: 5
(Katholieke Universiteit Leuven)
+ 10 AuthorsKato Rans2
Estimated H-index: 2
(Katholieke Universiteit Leuven)
In patients with prostate cancer who have a high risk of pelvic nodal disease, the use of elective whole pelvis radiotherapy is still controversial. Two large, randomised, controlled trials (RTOG 9413 and GETUG-01) did not show a benefit of elective whole pelvis radiotherapy over prostate-only radiotherapy. In 2020, the POP-RT trial established the role of elective whole pelvis radiotherapy in patients who have more than a 35% risk of lymph node invasion (known as the Roach formula). POP-RT stressed the importance of patient selection. In patients with cN1 (clinically node positive) disease or pN1 (pathologically node positive) disease, the addition of whole pelvis radiotherapy to androgen deprivation therapy significantly improved survival compared with androgen deprivation therapy alone, as shown in large, retrospective studies. This patient population might increase in the future because use of the more sensitive prostate-specific membrane antigen PET-CT will become the standard staging procedure. Additionally, the SPORTT trial suggested a benefit of whole pelvis radiotherapy in biochemical recurrence-free survival in the salvage setting. A correct definition of the upper field border, which should include the bifurcation of the abdominal aorta, is key in the use of pelvic radiotherapy. As a result of using modern radiotherapy technology, severe late urinary and intestinal toxic effects are rare and do not seem to increase compared with prostate-only radiotherapy.
#6Diogo Assed Bastos (USP: University of São Paulo)H-Index: 6
Abstract Background The role of extended pelvic lymph node dissection (EPLND) in the surgical management of prostate cancer (PCa) patients remains controversial, mainly because of a lack of randomized controlled trials (RCTs). Objective To determine whether EPLND has better oncological outcomes than limited PLND (LPLND. Design, setting and participants This was a prospective, single-center phase 3 trial in patients with intermediate- or high-risk clinically localized PCa. Intervention Randomizat...
#1Tejshri Telkhade (HBNI: Homi Bhabha National Institute)H-Index: 2
#2Vedang Murthy (HBNI: Homi Bhabha National Institute)H-Index: 7
Last. Rahul Krishnatry (HBNI: Homi Bhabha National Institute)H-Index: 14
view all 9 authors...
Abstract Aims The safety and efficacy of stereotactic body radiotherapy (SBRT) in localised prostate cancer are now established through phase III randomised trials. Its utility in node-positive prostate cancer is restricted due to a lack of controlled studies specifically addressing this subgroup. Herein we report the safety and efficacy of SBRT in this subgroup. Materials and methods In total, 60 patients treated with SBRT to prostate and pelvis were analysed. All patients received neoadjuvant ...
#1Kilian Schiller (TUM: Technische Universität München)H-Index: 13
#2Lucia Stöhrer (TUM: Technische Universität München)H-Index: 1
Last. Stephanie E. Combs (TUM: Technische Universität München)H-Index: 36
view all 13 authors...
Abstract Background Many patients experience recurrence of prostate cancer after radical prostatectomy. Objective The aim of this study was to visually analyze typical patterns of lymph node (LN) involvement for prostate cancer (PC) patients with biochemical recurrence after radical prostatectomy and lymphadenectomy by creating a color-coded heat map using gallium-68 prostate-specific membrane antigen positron emission tomography (68Ga-PSMA-PET) imaging. Further, we evaluated which LNs were cove...
#1Vedang Murthy (HBNI: Homi Bhabha National Institute)H-Index: 7
#2Priyamvada Maitre (HBNI: Homi Bhabha National Institute)H-Index: 3
Last. Reena Phurailatpam (HBNI: Homi Bhabha National Institute)H-Index: 11
view all 20 authors...
PURPOSEWe report the clinical outcomes of a randomized trial comparing prophylactic whole-pelvic nodal radiotherapy to prostate-only radiotherapy (PORT) in high-risk prostate cancer.METHODSThis pha...
#1Carlo Andrea Bravi (UniSR: Vita-Salute San Raffaele University)H-Index: 10
#2Nicola Fossati (UniSR: Vita-Salute San Raffaele University)H-Index: 44
Last. Alberto Briganti (UniSR: Vita-Salute San Raffaele University)H-Index: 99
view all 29 authors...
Abstract Background Long-term outcomes of patients treated with salvage lymph node dissection (sLND) for nodal recurrence of prostate cancer (PCa) remain unknown. Objective To investigate long-term oncological outcomes after sLND in a large multi-institutional series. Design, setting, and participants The study included 189 patients who experienced prostate-specific antigen (PSA) rise and nodal-only recurrence after radical prostatectomy (RP) and underwent sLND at 11 tertiary referral centers be...
#1Lucas C. MendezH-Index: 12
#2Andrew J. ArifinH-Index: 5
Last. David D'SouzaH-Index: 25
view all 13 authors...
Background Patients with high-risk prostate cancer are at increased risk of lymph node metastasis and are thought to benefit from whole pelvis radiotherapy (WPRT). There has been recent interest in the use of hypofractionated radiotherapy in treating prostate cancer. However, toxicity and cancer outcomes associated with hypofractionated WPRT are unclear at this time. This phase II study aims to investigate the impact in quality of life associated with hypofractionated WPRT compared to convention...
•PIVOTALboost evaluates benefits/toxicity of pelvic node RT and focal boost dose escalation.•Unfavourable intermediate/high risk and bulky local disease are most likely to benefit.•Functional MRI imaging is used to select patients for different types of dose escalation.•HDR brachytherapy or focal dose escalation with IMRT are used as options.•Training and support is provided to reduce variations of contouring and radiotherapy planning.•The trial is recruiting patients in 38 radiotherapy centres ...
#1F. Slevin (University of Leeds)H-Index: 4
#2M. Beasley (Leeds Teaching Hospitals NHS Trust)H-Index: 2
Last. Ann Henry (University of Leeds)H-Index: 34
view all 6 authors...
Abstract There is increasing use of radical prostatectomy to treat patients with high risk prostate cancer. This has contributed towards a pathological stage migration and a greater number of patients are subsequently being diagnosed with biochemical failure. There is increasing use of advanced imaging techniques in the setting of biochemical failure including positron emission tomography-computed tomography (PET-CT). This critical literature review highlights the evidence for PET-CT in post-pro...
#1William A. Hall (MCW: Medical College of Wisconsin)H-Index: 26
#2Eric S. Paulson (MCW: Medical College of Wisconsin)H-Index: 21
Last. Colleen A. Lawton (MCW: Medical College of Wisconsin)H-Index: 61
view all 25 authors...
Purpose In 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes (CTVs). Data have emerged further informing nodal recurrence patterns. The objective of this study is to provide an updated prostate pelvic nodal consensus atlas. Methods and materials A literature review was performed abstracting data on nodal recurrence patterns. Data were presented to a panel of international experts, inclu...
BACKGROUND In this study, we aim to present the clinical outcomes of radiotherapy (RT) in clinical pelvic lymph node-positive prostate cancer (cN1) patients. We also analyze the prognostic factors with focus on RT dose escalation to metastatic lymph nodes (LN). METHODS We retrospectively analyzed the data from cN1 patients who were treated with definitive RT and androgen deprivation therapy (ADT) between June 2004 and February 2016. All patients received localized irradiation to the prostate reg...
Cited By0
#1Vedang Murthy (HBNI: Homi Bhabha National Institute)H-Index: 7
#2Priyamvada Maitre (HBNI: Homi Bhabha National Institute)H-Index: 3
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