Treatment-related toxicity using prostate bed versus prostate bed and pelvic lymph node radiation therapy following radical prostatectomy: A national population-based study.

Autor:	Sujenthiran A; Clinical Effectiveness Unit, Royal College of Surgeons of England, UK.; Flatiron Health, UK., Parry MG; Clinical Effectiveness Unit, Royal College of Surgeons of England, UK.; Department of Health Services Research & Policy, LHSTM, UK., Dodkins J; Clinical Effectiveness Unit, Royal College of Surgeons of England, UK.; Department of Health Services Research & Policy, LHSTM, UK., Nossiter J; Department of Health Services Research & Policy, LHSTM, UK., Morris M; Clinical Effectiveness Unit, Royal College of Surgeons of England, UK.; Department of Health Services Research & Policy, LHSTM, UK., Berry B; Clinical Effectiveness Unit, Royal College of Surgeons of England, UK.; Department of Health Services Research & Policy, LHSTM, UK., Nathan A; Clinical Effectiveness Unit, Royal College of Surgeons of England, UK., Cathcart P; Department of Urology, Guy's & St Thomas' NHS Foundation Trust, UK., Clarke NW; Department of Urology, The Christie & Salford Royal NHS Foundation Trusts, UK., Payne H; Department of Oncology, University College London Hospitals, London, UK., van der Meulen J; Department of Health Services Research & Policy, LHSTM, UK., Aggarwal A; Department of Health Services Research & Policy, LHSTM, UK.; Department of Radiotherapy, Guy's & St Thomas' NHS Foundation Trust, UK.; Department of Cancer Epidemiology, Population & Global Health, KCL, UK.
Jazyk:	angličtina
Zdroj:	Clinical and translational radiation oncology [Clin Transl Radiat Oncol] 2023 Apr 11; Vol. 40, pp. 100622. Date of Electronic Publication: 2023 Apr 11 (Print Publication: 2023).
DOI:	10.1016/j.ctro.2023.100622
Abstrakt:	Purpose There is debate about the effectiveness and toxicity of pelvic lymph node (PLN) irradiation in addition to prostate bed radiotherapy when used to treat disease recurrence following radical prostatectomy. We compared toxicity from radiation therapy (RT) to the prostate bed and pelvic lymph nodes (PBPLN-RT) with prostatebed only radiation therapy (PBO-RT) following radical prostatectomy. Methods and Materials Patients with prostate cancer who underwent post-prostatectomy RT between 2010 and 2016 were identified by using the National Prostate Cancer Audit (NPCA) database. Follow-up data was available up to December 31, 2018. Validated outcome measures, based on a framework of procedural and diagnostic codes, were used to capture ≥Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicity. An adjusted competing-risks regression analysis estimated subdistribution hazard ratios (sHR). A sHR > 1 indicated a higher incidence of toxicity with PBPLN-RT than with PBO-RT. Results 5-year cumulative incidences in the PBO-RT (n = 5,087) and PBPLNRT (n = 593) groups was 18.2% and 15.9% for GI toxicity, respectively. For GU toxicity it was 19.1% and 20.7%, respectively. There was no evidence of difference in GI or GU toxicity after adjustment between PBO-RT and PBPLN-RT (GI: adjusted sHR, 0.90, 95% CI, 0.67-1.19; P = 0.45); (GU: adjusted sHR, 1.19, 95% CI, 0.99-1.44; P = 0.09). Conclusions This national population-based study found that including PLNs in the radiation field following radical prostatectomy is not associated with a significant increase in rates of ≥Grade 2 GI or GU toxicity at 5 years. Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: A.S. is an employee of Flatiron Health, an independent subsidiary of the Roche group, and holds stock in Roche. H.P. has attended and received honoraria for advisory boards, travel expenses to medical meetings, and served as a consultant for AstraZeneca, Astellas, Janssen, Sanofi Aventis, Takeda, Ipsen, Ferring, Sandoz, and Novartis. N.W.C. has attended and received honoraria for advisory boards, travel expenses to medical meetings, and served as a consultant for AstraZeneca, Astellas, Bayer, Janssen, Sanofi Aventis, Takeda, Ipsen and Ferring. J.v.d.M. reports a contract with the Healthcare Quality Improvement Partnership for the provision of the National Prostate Cancer Audit (www.npca.org.uk) funded by the Healthcare Quality Improvement Partnership (www.hqip.org.uk). (© 2023 The Authors.)
Databáze:	MEDLINE
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