Department of Urology, Ghent University Hospital, Ghent, Belgium.
Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
Eur Urol. 2019 Dec;76(6):732-739. doi: 10.1016/j.eururo.2019.07.009. Epub 2019 Jul 20.
Stereotactic body radiotherapy (SBRT) and elective nodal radiotherapy (ENRT) are being investigated as metastasis-directed treatments in oligorecurrent prostate cancer (PC); however, comparative data are still lacking.
To compare outcome and toxicity between both treatments. Primary endpoint was metastasis-free survival, adjusted for selected variables (aMFS).
DESIGN, SETTING, AND PARTICIPANTS: This was a multi-institutional, retrospective analysis of 506 (SBRT: 309, ENRT: 197) patients with hormone-sensitive nodal oligorecurrent PC (five or fewer lymph nodes (LNs; N1/M1a), treated between 2004 and 2017. Median follow-up was 36 mo (interquartile range 23-56).
SBRT was defined as a minimum of 5 Gy per fraction to each lesion with a maximum of 10 fractions. ENRT was defined as a minimum dose of 45 Gy in up to 25 fractions to the elective nodes, with or without a simultaneous boost to the suspicious node(s). The choice of radiotherapy (RT) was at the discretion of the treating physician, with treatments being unbalanced over the centers.
In total, 506 patients from 15 different treatment centers were included. Primary treatment was radical prostatectomy, RT, or their combination. Nodal recurrences were detected by positron emission tomography/computer tomography (97%) or conventional imaging (3%). Descriptive statistics was used to summarize patient characteristics.
ENRT was associated with fewer nodal recurrences compared with SBRT (p < 0.001). In a multivariable analysis, patients with one LN at recurrence had longer aMFS after ENRT (hazard ratio: 0.50, 95% confidence interval 0.30-0.85, p = 0.009). Late toxicity was higher after ENRT compared with that after SBRT (16% vs. 5%, p < 0.01). Limitations include higher use of hormone therapy in the ENRT cohort and nonstandardized follow-up.
ENRT reduces the number of nodal recurrences as compared with SBRT, however at higher toxicity. Our findings hypothesize that ENRT should be preferred to SBRT in the treatment of nodal oligorecurrences. This hypothesis needs to be evaluated in a randomized trial.
This study investigated the difference between stereotactic and elective nodal radiotherapy in treating limited nodal metastatic prostate cancer. Nodal relapse was less frequent following elective nodal radiotherapy than following stereotactic body radiotherapy, and thus elective nodal radiotherapy might be the preferred treatment.
立体定向体部放疗（SBRT）和选择性淋巴结放疗（ENRT）正被作为寡复发前列腺癌（PC）的转移导向治疗方法进行研究；然而，目前仍缺乏比较数据。
比较两种治疗方法的疗效和毒性。主要终点是调整了选定变量的无转移生存（aMFS）。
设计、地点和参与者：这是一项多机构、回顾性分析，纳入了 506 例（SBRT：309 例，ENRT：197 例）激素敏感的寡复发淋巴结（5 个或更少淋巴结（N1/M1a）的 PC 患者，治疗时间为 2004 年至 2017 年。中位随访时间为 36 个月（四分位距 23-56）。
SBRT 定义为每个病灶至少 5Gy 分割，最大 10 次分割。ENRT 定义为对选择性淋巴结给予 45Gy 最低剂量，最多 25 次分割，同时对可疑淋巴结（多个）进行同步增敏。放疗（RT）的选择由治疗医生决定，治疗在中心之间不平衡。
共纳入来自 15 个不同治疗中心的 506 例患者。主要治疗方法为根治性前列腺切除术、放疗或联合治疗。通过正电子发射断层扫描/计算机断层扫描（97%）或常规影像学（3%）检测淋巴结复发。采用描述性统计方法总结患者特征。
与 SBRT 相比，ENRT 导致的淋巴结复发较少（p<0.001）。多变量分析显示，复发时仅 1 个淋巴结的患者接受 ENRT 后 aMFS 更长（风险比：0.50，95%置信区间 0.30-0.85，p=0.009）。与 SBRT 相比，ENRT 后晚期毒性更高（16%比 5%，p<0.01）。局限性包括在 ENRT 组中更多地使用激素治疗和非标准化的随访。
与 SBRT 相比，ENRT 减少了淋巴结复发的数量，但毒性更高。我们的研究结果假设，在治疗淋巴结寡复发时，ENRT 应优于 SBRT。这一假设需要在随机试验中进行评估。
本研究探讨了立体定向和选择性淋巴结放疗在治疗局限性淋巴结转移性前列腺癌中的差异。与 SBRT 相比，选择性淋巴结放疗后淋巴结复发的频率较低，因此选择性淋巴结放疗可能是首选治疗方法。
