Avoiding prostate bed radiation for the PSMA-PET detected nodal recurrence patient post prostatectomy.

Autor:	Challis B; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.; Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia., Kneebone A; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.; Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.; Genesis Care, Mater Hospital, North Sydney, Sydney, NSW, Australia.; Central Coast Cancer Centre, Radiation Oncology Unit, Gosford Hospital, Gosford, NSW, Australia., Eade T; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.; Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.; Genesis Care, Mater Hospital, North Sydney, Sydney, NSW, Australia.; Central Coast Cancer Centre, Radiation Oncology Unit, Gosford Hospital, Gosford, NSW, Australia., Guo L; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia., Atyeo J; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia., Brown C; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.; National Health and Medical Research Council, Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia., Hruby G; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.; Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.; Genesis Care, Mater Hospital, North Sydney, Sydney, NSW, Australia.
Jazyk:	angličtina
Zdroj:	Clinical and translational radiation oncology [Clin Transl Radiat Oncol] 2024 Nov 26; Vol. 50, pp. 100896. Date of Electronic Publication: 2024 Nov 26 (Print Publication: 2025).
DOI:	10.1016/j.ctro.2024.100896
Abstrakt:	Background: Nodal only recurrence post radical prostatectomy (RP) is increasingly recognised in the PSMA scan era. Management is controversial with a curative approach usually incorporating prostate bed and nodal irradiation (PB + NRT) in combination with long-term hormonal therapy. It is unknown whether omitting prostate-bed irradiation (PBRT) is safe in a subgroup of these patients. Purpose: To document the outcomes for pelvic nodal only salvage radiation therapy (NRT) plus concurrent androgen deprivation therapy (ADT) for patients with PSMA PET documented nodal relapses. Methods and Materials: Eligible patients included PSMA PET documented nodal only relapses post RP who received NRT with or without PBRT at Royal North Shore Hospital (NSCC), Gosford Hospital (CCCC) or Genesis Care (GC) between January 2015 and December 2021. Baseline demographics, surgical pathology, radiation details, ADT use and outcomes were documented. Results: Forty-six patients were identified, 22 in the PB + NRT cohort and 24 in the NRT cohort. Compared to the PBRT + NRT group, the NRT cohort had lower stage disease (pT2 = 7 (29 %), pT3a = 15 (63 %), pT3b = 1 (4 %) vs pT2 = 0, pT3a = 10 (45 %), pT3b = 12 (55 %)) (p=<0.001) and lower rates of R1 resection (0 % vs 63.6 % (n = 14)) (p < 0.001) respectively. The median follow-up from radiotherapy was 3.9 years.Four-year biochemical failure- free survival (BFFS) was 64 % in the NRT group vs 67 % in the PB + NRT group. Of the ten (41.6 %) failures in the NRT group, 1 (4 %) was a biochemical failure only, 2 (8 %) recurred in the PB and received further salvage treatment, 4 (17 %) had nodal failure outside the pelvis and 3 (13 %) had distant metastases.One patient (4 %) in the NRT group recorded late grade ≥2 GU toxicity compared with 7 (32 %) in the PB + NRT. No patients in the NRT group recorded late grade ≥2 GI toxicity compared with 2 (9 %) in the PB + NRT cohort. Conclusion: This study provides early evidence for the feasibility of PBRT sparing to avoid local toxicity. Most patients in this cohort failed distantly. This data suggests that for selected men PB-avoidance may be considered given informed consent. (Crown Copyright © 2024 Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu