PSMA-positive nodal recurrence in prostate cancer : Salvage radiotherapy is superior to salvage lymph node dissection in retrospective analysis
Autor: | Chukwuka Eze, Minglun Li, Ute Ganswindt, Harun Ilhan, Christian Schaefer, Christian G. Stief, Alexander Buchner, Alexander Kretschmer, Wolfgang P. Fendler, Peter Bartenstein, Claus Belka, Nina-Sophie Schmidt-Hegemann, Paul Rogowski |
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Rok vydání: | 2019 |
Předmět: |
Glutamate Carboxypeptidase II
Male medicine.medical_treatment 030232 urology & nephrology Kaplan-Meier Estimate Androgen deprivation therapy 0302 clinical medicine Positron Emission Tomography Computed Tomography Salvage lymph node dissection Medicine Lymph node Aged 80 and over Prostate cancer Prostatectomy Hazard ratio Middle Aged medicine.anatomical_structure Oncology Biochemical persistence 030220 oncology & carcinogenesis Lymphatic Metastasis Antigens Surface Original Article Biochemical recurrence medicine.medical_specialty Urology Gallium Radioisotopes Adenocarcinoma Disease-Free Survival 03 medical and health sciences Antigens Neoplasm Humans Radiology Nuclear Medicine and imaging Survival analysis Aged Neoplasm Staging Retrospective Studies Salvage Therapy Lymphatic Irradiation Radiotherapy business.industry Prostatic Neoplasms Retrospective cohort study Log-rank test Lymph Node Excision Radiopharmaceuticals business PSMA PET/CT Follow-Up Studies |
Zdroj: | Strahlentherapie Und Onkologie |
ISSN: | 1439-099X |
Popis: | Purpose This analysis compares salvage lymph node dissection (SLND) to salvage lymph node radiotherapy (SLNRT) of 68Ga-PSMA PET-positive nodal recurrences after radical prostatectomy (RPE). Methods A total of 67 SLNRT and 33 SLND consecutive patients with pelvic and/or para-aortic nodal recurrences after RPE were retrospectively analyzed. Biochemical recurrence-free survival rates (bRFS; PSA p Results Median follow-up was 17 months (range, 6–53 months) in SLND patients and 31 months (range, 3–56 months) in SLNRT patients (p = 0.027). SLNRT patients had significantly more tumours of pT3 and pT4 category (82% vs. 67%; p = 0.006), pathologically involved lymph nodes (45% vs. 27%; p = 0.001) and positive surgical margins (54% vs. 12%; p = 0.001) at time of RPE than SLND patients. PSA persistence after RPE was significantly more frequently observed in the SLNRT cohort (73% vs. 27%; p = 0.001). There was no significant difference in the distribution of PET-positive lymph nodes. Median PSA before SLND was higher than before SLNRT (3.07 ng/ml vs. 1.3 ng/ml; p = 0.393). The 2‑year bRFS was significantly higher in the SLNRT vs. the SLND cohort (92% vs. 30%; p = 0.001) with lower rates of distant metastases (21% vs. 52%; p = 0.002) and secondary treatments (5% vs. 39%; p = 0.011) irrespective of ongoing androgen deprivation therapy at last contact. In multivariable analysis, SLNRT was significantly associated with prolonged bRFS (regression coefficient 1.436, hazard ratio 4.204, 95% CI 1.789–9.878; p = 0.001). Conclusion Based on this retrospective study SLNRT might be the preferred treatment option for patients with nodal recurrence after previous RPE. |
Databáze: | OpenAIRE |
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