Rischke Hans Christian, Schultze-Seemann Wolfgang, Wieser Gesche, Krönig Malte, Drendel Vanessa, Stegmaier Petra, Krauss Tobias, Henne Karl, Volegova-Neher Natalia, Schlager Daniel, Kirste Simon, Grosu Anca-Ligia, Jilg Cordula Annette
Department of Radiation Oncology, University of Freiburg, Freiburg, Germany.
Strahlenther Onkol. 2015 Apr;191(4):310-20. doi: 10.1007/s00066-014-0763-5. Epub 2014 Oct 18.
Nodal pelvic/retroperitoneal recurrent prostate cancer (PCa) after primary therapy can be treated with salvage lymph node dissection (salvage-LND) in order to delay disease progression and offer cure for a subset of patients. Whether adjuvant radiotherapy (ART) in affected regions improves the outcome by elimination of residual tumour burden remains unclear.
A total of 93 patients with exclusively nodal PCa relapse underwent choline-positron-emission tomography-computed-tomography-directed pelvic/retroperitoneal salvage-LND; 46 patients had surgery only and 47 patients received ART in regions with proven lymph node metastases. In case of subsequent prostate specific antigen (PSA) progression, different imaging modalities were performed to confirm next relapse within or outside the treated region (TR). Mean follow-up was 3.2 years.
Lymphatic tumour burden was balanced between the two groups. Additional ART resulted in delayed relapse within TR (5-year relapse-free rate 70.7 %) versus surgery only (5-year relapse-free rate 26.3 %, p < 0.0001). In both treatment arms, time to next relapse outside the TR was almost equal (median 27 months versus 29.6 months, p = 0.359). With respect to the detection of the first new lesion, regardless if present within or outside the TR, 5 years after the treatment 34.3 % of patients in the group with additional ART were free of relapse, versus 15.4 % in the surgery only group (p = 0.0122). ART had no influence on the extent of PSA reduction at latest follow-up compared to treatment with surgery only.
ART after salvage-LND provides stable local control in TR and results in overall significant improved next-relapse-free survival, compared to patients who received surgery only in case of nodal PCa-relapse.
原发性治疗后盆腔/腹膜后淋巴结复发的前列腺癌（PCa）可通过挽救性淋巴结清扫术（挽救性LND）进行治疗，以延缓疾病进展并为部分患者提供治愈机会。受累区域的辅助放疗（ART）是否通过消除残余肿瘤负荷来改善预后仍不清楚。
共有93例单纯淋巴结PCa复发的患者接受了胆碱正电子发射断层扫描-计算机断层扫描引导下的盆腔/腹膜后挽救性LND；46例患者仅接受手术，47例患者在证实有淋巴结转移的区域接受了ART。如果随后出现前列腺特异性抗原（PSA）进展，则采用不同的成像方式来确认在治疗区域（TR）内或外的下一次复发。平均随访时间为3.2年。
两组的淋巴肿瘤负荷相当。额外的ART导致TR内复发延迟（5年无复发生存率70.7%），而单纯手术组为（5年无复发生存率26.3%，p<0.0001）。在两个治疗组中，TR外的下一次复发时间几乎相同（中位数分别为27个月和29.6个月，p=0.359）。关于第一个新病灶的检测，无论其出现在TR内还是外，治疗后5年，接受额外ART治疗组的患者中有34.3%无复发，而单纯手术组为15.4%（p=0.0122）。与单纯手术治疗相比，ART对最新随访时PSA降低的程度没有影响。
与单纯接受手术治疗的淋巴结PCa复发患者相比，挽救性LND后进行ART可在TR内提供稳定的局部控制，并显著提高总体无复发生存率。
