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

Jörg Tamihardja; Leonie Zehner; Philipp Hartrampf; Dominik Lisowski; Susanne Kneitz; Sinan Cirsi; Gary Razinskas; Michael Flentje; Bülent Polat

doi:10.3390/cancers14153766

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 (Basel). 2022 Aug 2;14(15):3766. doi: 10.3390/cancers14153766.

Authors

Jörg Tamihardja¹, Leonie Zehner¹, Philipp Hartrampf², Dominik Lisowski¹, Susanne Kneitz³, Sinan Cirsi¹, Gary Razinskas¹, Michael Flentje¹, Bülent Polat¹

Affiliations

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.

Abstract

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 (EQD2_1.5Gy) 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.

Keywords: PSMA; long-term outcome; metastasis-directed therapy; oligorecurrence; prostate cancer; salvage radiotherapy.

Grants and funding

This publication was supported by the Open Access Publication Fund of the University of Wuerzburg.