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
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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