Extended-field radiation therapy for prostatic carcinoma with para-aortic lymph node metastasis.

The finding of involvement of para-aortic lymph nodes in patients with adenocarcinoma of the prostate has been considered so ominous that further therapy has often only been palliative. What is the proportion of patients with carcinoma of the prostate with regional metastasis limited to the infra-diaphragmatic lymph nodes who might be cured or at least offered long-term progression-free survival by aggressive treatment? From June 1970 through March 1983, 114 patients were treated with curative intent for adenocarcinoma of the prostate, clinical Stage III, at the Medical College of Wisconsin Affiliated Hospitals. Twenty-three of these patients had evidence of metastasis to the para-aortic lymph nodes. These patients were treated aggressively with external radiation therapy to the entire pelvis and para-aortic region. The median dose to the prostate was 70 Gy, the pelvis 54 Gy, and the para-aortic region 50 Gy. The median period of observation after treatment was 53.5 months. The actuarial survival was 90% at 5 years and progression-free survival was 73% at 5 years. The rate of major complications was 4.3%. Although the number of patients is small, the data suggest that extended field radiation therapy can result in prolonged progression-free survival and perhaps cure many patients with juxtaregional dissemination of adenocarcinoma of the prostate.