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Article

Salvage Nodal Radiotherapy as Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer Detected by Positron Emission Tomography Shows Favorable Outcome in Long-Term Follow-Up

1
Department of Radiation Oncology, University of Wuerzburg, 97080 Wuerzburg, Germany
2
Department of Nuclear Medicine, University of Wuerzburg, 97080 Wuerzburg, Germany
3
Biochemistry and Cell Biology, Biocenter, University of Wuerzburg, 97074 Wuerzburg, Germany
*
Author to whom correspondence should be addressed.
Academic Editor: Robert Michael Hermann
Cancers 2022, 14(15), 3766; https://doi.org/10.3390/cancers14153766
Received: 23 June 2022 / Revised: 31 July 2022 / Accepted: 1 August 2022 / Published: 2 August 2022
Patients, who suffer from oligorecurrent prostate cancer with limited nodal involvement, may be offered positron emission tomography (PET)-directed salvage nodal radiotherapy to delay disease progression. This current analysis aimed to access salvage radiotherapy for nodal oligorecurrent prostate cancer with simultaneous integrated boost to PET-involved lymph nodes as metastasis-directed therapy. A long-term oncological outcome was favorable after salvage nodal radiotherapy and severe toxicity rates were low. Androgen deprivation therapy plays a major role in recurrent prostate cancer management and demonstrates a positive influence on the rate of biochemical progression in patients receiving salvage nodal radiotherapy. The present long-term analysis may help clinicians identify patients who would benefit from salvage nodal radiotherapy and androgen deprivation therapy, as a multimodal treatment strategy for oligorecurrent prostate cancer.
Background: The study aimed to access the long-term outcome of salvage nodal radiotherapy (SNRT) in oligorecurrent prostate cancer. Methods: A total of 95 consecutive patients received SNRT for pelvic and/or extrapelvic nodal recurrence after prostate-specific membrane antigen (PSMA) or choline PET from 2010 to 2021. SNRT was applied as external beam radiotherapy with simultaneous integrated boost up to a median total dose of 62.9 Gy (EQD21.5Gy) to the recurrent lymph node metastases. The outcome was analyzed by cumulative incidence functions with death as the competing risk. Fine–Gray regression analyses were performed to estimate the relative hazards of the outcome parameters. Genitourinary (GU)/gastrointestinal (GI) toxicity evaluation utilized Common Toxicity Criteria for Adverse Events (v5.0). The results are as follows: the median follow-up was 47.1 months. The five-year biochemical progression rate (95% CI) was 50.1% (35.7–62.9%). Concomitant androgen deprivation therapy (ADT) was adminstered in 60.0% of the patients. The five-year biochemical progression rate was 75.0% (42.0–90.9%) without ADT versus 35.3% (19.6–51.4%) with ADT (p = 0.003). The cumulative five-year late grade 3 GU toxicity rate was 2.1%. No late grade 3 GI toxicity occured. Conclusions: Metastasis-directed therapy through SNRT for PET-staged oligorecurrent prostate cancer demonstrated a favorable long-term oncologic outcome. Omittance of ADT led to an increased biochemical progression. View Full-Text
Keywords: metastasis-directed therapy; long-term outcome; oligorecurrence; prostate cancer; salvage radiotherapy; PSMA metastasis-directed therapy; long-term outcome; oligorecurrence; prostate cancer; salvage radiotherapy; PSMA
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MDPI and ACS Style

Tamihardja, J.; Zehner, L.; Hartrampf, P.; Lisowski, D.; Kneitz, S.; Cirsi, S.; Razinskas, G.; Flentje, M.; Polat, B. Salvage Nodal Radiotherapy as Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer Detected by Positron Emission Tomography Shows Favorable Outcome in Long-Term Follow-Up. Cancers 2022, 14, 3766. https://doi.org/10.3390/cancers14153766

AMA Style

Tamihardja J, Zehner L, Hartrampf P, Lisowski D, Kneitz S, Cirsi S, Razinskas G, Flentje M, Polat B. Salvage Nodal Radiotherapy as Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer Detected by Positron Emission Tomography Shows Favorable Outcome in Long-Term Follow-Up. Cancers. 2022; 14(15):3766. https://doi.org/10.3390/cancers14153766

Chicago/Turabian Style

Tamihardja, Jörg, Leonie Zehner, Philipp Hartrampf, Dominik Lisowski, Susanne Kneitz, Sinan Cirsi, Gary Razinskas, Michael Flentje, and Bülent Polat. 2022. "Salvage Nodal Radiotherapy as Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer Detected by Positron Emission Tomography Shows Favorable Outcome in Long-Term Follow-Up" Cancers 14, no. 15: 3766. https://doi.org/10.3390/cancers14153766

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