The outcome for pathological node positive prostate cancer patients treated with intensity-modulated radiotherapy and androgen deprivation therapy: a case-matched analysis of pN1 and pN0 patients

Publication date: Available online 16 June 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): A. Van Hemelryk, G. De Meerleer, P. Ost, F. Poelaert, W. De Gersem, K. Decaestecker, P. De Visschere, V. Fonteyne
Introductionand Objective: Improved outcome is reported after surgery or external beam radiotherapy (EBRT) + androgen deprivation therapy (ADT) for patients with lymph node (LN) positive (N1) prostate cancer (PC). Surgical series showed that not all patients with pathological (p)N1 PC behave the same. The aim of this study is to perform a matched-case analysis to compare the outcome of pN1 and pN0 PC after high dose EBRT+ADT.Material and MethodsRadiotherapy up to 80Gy was delivered to the prostate with a minimal dose of 45Gy to the pelvis for pN1 patients. After matching, Kaplan Meier statistics were used to compare 5-year biochemical and clinical relapse free survival (bRFS and cRFS), prostate cancer specific (PCSS) and overall survival (OS). Acute and late rectal and urinary toxicity was evaluated.ResultsSixty-nine pN1 PC patients were matched 1:1 with pN0 PC patients. Median follow-up was 60 months. Five-year bRFS and cRFS for pN1 versus pN0 PC patients were 65±7% versus 79±5% (p=0.08) and 70±6% versus 83±5% (p=0.04) respectively. No significant difference was found in bRFS or cRFS rates between low volume pN1 (≤2 positive LNs) and pN0 patients. Five-year PCSS and OS were comparable between pN1 and pN0 PC patients (PCSS: 92%±4% vs. 93%±3%, p=0.66; OS: 82%±5% vs. 80%±5%, p=0.58). Severe toxicity was rare for both groups, although pN1 patients experienced significantly more acute rectal toxicity grade 2.ConclusionPrimary EBRT plus 2-3 years of ADT is a legitimate treatment option for pN1 PC patients, especially those with ≤2 positive LNs, and this with bRFS and cRFS rates comparable to pN0 PC patients. For pN1 PC with >2 positive LNs bRFS and cRFS are worse compared to pN0 patients, but even in this subgroup long term disease control is obtained.

Teaser

In this matched case analysis, the outcome of pathological node positive (pN1) prostate cancer (PC) patients is compared to pathological node negative (pN0) PC patients after external beam radiotherapy (EBRT) + androgen deprivation (ADT). This study confirms that EBRT plus 2-3 years of ADT is a legitimate treatment option for pN1 PC patients, especially those with ≤2 positive lymph nodes (LNs). Also for pN1 PC with >2 positive lymph nodes long term disease control is obtained.


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