Comparing Radiotherapies for Nodal Oligorecurrent Prostate Cancer
Posted: Tuesday, March 10, 2020
Although it may come at a cost of higher toxicity, elective nodal radiotherapy may be a better choice than stereotactic body radiotherapy to increase the chance of metastasis-free survival in patients with oligorecurrent prostate cancer. In fact, with elective nodal radiotherapy, the occurrence of nodal relapse was less frequent. Elise De Bleser, MD, of Ghent University Hospital, Belgium, and colleagues presented the results of their 506-patient retrospective analysis in European Urology.
Of the cohort, all of whom had hormone-sensitive nodal disease with five or fewer affected lymph nodes, 309 were treated with stereotactic body radiotherapy, and 197 with elective nodal radiotherapy between 2004 and 2017. Primary treatments were radical prostatectomy, radiotherapy, or a combination of the two. In the treatment of regional or distant metastases, “the choice of radiotherapy was at the discretion of the treating physician, with treatments being unbalanced” over the 15 institutions at which the patients were treated, the authors noted.
After an adjustment for significant variables and a median follow-up of 36 months, elective nodal radiotherapy was associated with significantly fewer nodal recurrences than stereotactic body radiotherapy (P < .001). The 3-year metastasis-free survival was 77% with elective nodal radiotherapy and 68% with stereotactic body radiotherapy (P = .01). Late toxicity, however, was higher after elective nodal radiotherapy than after stereotactic body radiotherapy (16% vs. 5%; P < .01).
Based on their findings, Dr. de Bleser and co-researchers hypothesized: “Elective nodal radiotherapy should be preferred to stereotactic body radiotherapy in the treatment of nodal oligorecurrences.” However, they added, “this hypothesis needs to be evaluated in a randomized trial.”
Disclosure: For full disclosures of the study authors, visit europeanurology.com.