Patterns of recurrence after prostate bed radiotherapy.
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Date
2019-12-01Author
Brand, DH
Parker, JI
Dearnaley, DP
Eeles, R
Huddart, R
Khoo, V
Murray, J
Suh, Y-E
Tree, AC
van As, N
Parker, C
Type
Journal Article
Metadata
Show full item recordAbstract
BACKGROUND AND PURPOSE: Prostate bed radiotherapy is a standard treatment after radical prostatectomy. Recent evidence suggests that, for patients with a PSA > 0.34 ng/ml, the radiotherapy treatment volume should include not only the prostate bed but also the pelvic lymph nodes. We describe the patterns of failure after prostate bed radiotherapy, focussing on the proportion of patients with radiologically confirmed pelvic nodal failure only, in the absence of distant disease. MATERIALS AND METHODS: Patients included were men receiving prostate bed radiotherapy at the Royal Marsden Hospital between 1997 and 2013. The key outcome of interest was the pattern of radiologic failure after prostate bed radiotherapy. Baseline characteristics of patients experiencing pelvic nodal failure without distant disease were compared versus all other relapse patterns. Comparisons were by Chi-square test, with multiple testing adjusted p < 0.005 significant. RESULTS: 140 of 322 patients developed biochemical failure after salvage RT. Radiologic failure occurred in 89 patients. 35 of the 89 patients (39%) with radiologic failure had pelvic nodal failure without distant disease, with no significant differences in baseline characteristics when compared to all other patients. The rate of pelvic nodal failure was the same for patients with PSA above or below 0.34 ng/ml (16/149, 95% CI = 6-17% vs 19/171, 95% CI = 7-17%). CONCLUSIONS: Pelvic lymph node disease, without more distant disease, is a common site of failure in men receiving radiotherapy to the prostate bed, including those with PSA < 0.34 ng/ml. This observation informs the case for including the pelvic lymph nodes in the radiotherapy treatment volume.
Subject
Pelvis
Lymph Nodes
Humans
Prostatic Neoplasms
Neoplasm Recurrence, Local
Prostate-Specific Antigen
Adult
Aged
Middle Aged
Male
Research team
Clinical Academic Radiotherapy (Dearnaley)
Clinical Academic Radiotherapy (Huddart)
Oncogenetics
Stereotactic and Precision Body Radiotherapy
Language
eng
Date accepted
2019-09-05
License start date
2019-12
Citation
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2019, 141 pp. 174 - 180
Publisher
ELSEVIER IRELAND LTD