Introduction: The treatment of patients with prostate cancer and a high risk of lymphatic involvement is a matter of discussion. Several trials, including some recent randomised trials suggest a role for pelvic lymph node irradiation (whole pelvis radiation WPR) in combination with neoadjuvant and adjuvant hormone treatment but a proven survival benefit has not been shown. Since nearly all studies used nomograms to estimate the presence of lymphatic metastases, or even excluded patients with histological proved metastases, the impact of WPR could be underestimated. We evaluated the efficacy and the toxicity of WPR in patients with histological proven lymphatic metastases. Methods: We retrospectively examined patients with histological proven lymph node metastases of prostate cancer. The patients were divided into 2 groups, one treated with WPR with a boost on the prostate and 3 years of antiandrogen therapy and one group treated only with hormonal therapy (HT). Results: In the period 2002-2009 182 diagnostic lymph node dissections (LND) or sentinel procedures were performed. 55 patients had lymph node metastases and 30 were treated with WPR and 3 years adjuvant androgen ablation and 23 patients were treated with HT only. Of the WPR group, only 7% (n=2) had a biochemical recurrence ((PSA> nadir + 2 ng/ml) within 5 years. None of the patients had clinical progression or died. 50% of the HT only group showed a PSA>2 within 5 years. The number of removed and positive lymph nodes swell as the pre-treatment PSA did not differ between the two groups. Acute radiotoxicity in the form of grade 1 to 2 proctitis was diagnosed in 15 patients (50%), grade 1 to 3 radiation cystitis in 18 patients (60%). After 90 days, 6 patients (20%) had proctitis grade 1 to 2. No NCI-CTC degree 4 toxicity occurred. Conclusion: WPR is a safe treatment for patients with prostate cancer and proven lymphatic involvement with al long biochemical respons. The definite radiation target volume, the duration of the hormone therapy as well as the therapeutic profit remains a point of study.
|Number of pages||7|
|Journal||Nederlands Tijdschrift voor Urologie|
|Publication status||Published - 1 Dec 2010|
- Lymph node metastases
- Prostate cancer
- Whole-pelvic radiation therapy
ASJC Scopus subject areas