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Fodor A, Brombin C, Chiti A, Di Muzio NG. Lymph node oligometastases from prostate cancer: extensive or localized treatments - do we have a basis to decide? Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06837-0. [PMID: 38992160 DOI: 10.1007/s00259-024-06837-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Affiliation(s)
- Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, 60, Olgettina street, Milan, 20132, Italy.
| | - Chiara Brombin
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Arturo Chiti
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Gisella Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, 60, Olgettina street, Milan, 20132, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Trapp C, Aebersold DM, Belka C, Casuscelli J, Emmett L, Eze C, Fanti S, Farolfi A, Fendler W, Grosu AL, Guckenberger M, Hruby G, Kirste S, Koerber SA, Kroeze S, Peeken JC, Rogowski P, Scharl S, Shelan M, Spohn SKB, Strouthos I, Unterrainer L, Vogel M, Wiegel T, Zamboglou C, Schmidt-Hegemann NS. Whole pelvis vs. hemi pelvis elective nodal radiotherapy in patients with PSMA-positive nodal recurrence after radical prostatectomy - a retrospective multi-institutional propensity score analysis. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06802-x. [PMID: 38940843 DOI: 10.1007/s00259-024-06802-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Despite growing evidence for bilateral pelvic radiotherapy (whole pelvis RT, WPRT) there is almost no data on unilateral RT (hemi pelvis RT, HPRT) in patients with nodal recurrent prostate cancer after prostatectomy. Nevertheless, in clinical practice HPRT is sometimes used with the intention to reduce side effects compared to WPRT. Prostate-specific membrane antigen positron emission tomography / computed tomography (PSMA-PET/CT) is currently the best imaging modality in this clinical situation. This analysis compares PSMA-PET/CT based WPRT and HPRT. METHODS A propensity score matching was performed in a multi-institutional retrospective dataset of 273 patients treated with pelvic RT due to nodal recurrence (214 WPRT, 59 HPRT). In total, 102 patients (51 in each group) were included in the final analysis. Biochemical recurrence-free survival (BRFS) defined as prostate specific antigen (PSA) < post-RT nadir + 0.2ng/ml, metastasis-free survival (MFS) and nodal recurrence-free survival (NRFS) were calculated using the Kaplan-Meier method and compared using the log rank test. RESULTS Median follow-up was 29 months. After propensity matching, both groups were mostly well balanced. However, in the WPRT group there were still significantly more patients with additional local recurrences and biochemical persistence after prostatectomy. There were no significant differences between both groups in BRFS (p = .97), MFS (p = .43) and NRFS (p = .43). After two years, BRFS, MFS and NRFS were 61%, 86% and 88% in the WPRT group and 57%, 90% and 82% in the HPRT group, respectively. Application of a boost to lymph node metastases, a higher RT dose to the lymphatic pathways (> 50 Gy EQD2α/β=1.5 Gy) and concomitant androgen deprivation therapy (ADT) were significantly associated with longer BRFS in uni- and multivariate analysis. CONCLUSIONS Overall, this analysis presents the outcome of HPRT in nodal recurrent prostate cancer patients and shows that it can result in a similar oncologic outcome compared to WPRT. Nevertheless, patients in the WPRT may have been at a higher risk for progression due to some persistent imbalances between the groups. Therefore, further research should prospectively evaluate which subgroups of patients are suitable for HPRT and if HPRT leads to a clinically significant reduction in toxicity.
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Affiliation(s)
- Christian Trapp
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | | | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Wolfgang Fendler
- Department of Nuclear Medicine, University Hospital,University of Essen, Essen, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center , University of Freiburg, Freiburg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital, University of Zurich, Zurich, Switzerland
| | - George Hruby
- Department of Radiation Oncology, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center , University of Freiburg, Freiburg, Germany
| | - Stefan A Koerber
- Department of Radiation Oncology, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephanie Kroeze
- Department of Radiation Oncology, University Hospital, University of Zurich, Zurich, Switzerland
| | - Jan C Peeken
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sophia Scharl
- Department of Radiation Oncology, University of Ulm, Ulm, Germany
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon K B Spohn
- Department of Radiation Oncology, Medical Center , University of Freiburg, Freiburg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programm, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Iosif Strouthos
- Department of Radiation Oncology, German Oncology Center, European University Cyprus, Nicosia, Cyprus
| | - Lena Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Marco Vogel
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, University of Ulm, Ulm, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center , University of Freiburg, Freiburg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Freiburg, Freiburg, Germany
- Department of Radiation Oncology, German Oncology Center, European University Cyprus, Nicosia, Cyprus
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Rodler S, Danninger D, Eismann L, Kazmierczak PM, Jokisch F, Li M, Becker A, Kretschmer A, Stief C, Westhofen T. Health-related quality of life following salvage radical prostatectomy for recurrent prostate cancer after radiotherapy or focal therapy. World J Urol 2024; 42:242. [PMID: 38635030 PMCID: PMC11026200 DOI: 10.1007/s00345-024-04945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Salvage radical prostatectomy (sRP) is an important treatment option for patients with recurrent prostate cancer (PCa) after radiotherapy (RT) or focal therapy (FT). However, health-related quality of life (HRQOL) after sRP depending on the primary treatment is understudied. METHODS Patients who underwent Salvage RP for recurrent PCa were analyzed. The primary outcome of this study was HRQOL assessed by the quality-of-life questionnaire (QLQ)-C30 and its prostate specific QLQ-PR25 add-on. Secondary outcomes were functional outcome parameters (erectile function, continence) and biochemical recurrence-free survival (BRFS). Statistical analyses employed the chi-square test, Mann-Whitney U test, and Kaplan-Meier method, with a p value < 0.05 denoting significance. RESULTS 37 patients with RT as primary treatment (RT-sRP) and 22 patients with focal therapy prior sRP (FT-sRP) were analyzed. Mean global health score was not significantly different preoperatively (71.9 vs. 67.3, p = 0.89) as well as after a median of 32 months follow-up (54.9 vs. 50.6, p = 0.63) with impaired HRQOL after sRP in both groups. Baseline erectile dysfunction was more prevalent in the RT-sRP group (mean IIEF-5: 5.0) than in the FT-sRP group (mean IIEF-5: 8.5, p = 0.037). No differences were observed at follow-up for erectile function (IIEF-5-Score: 0.5 vs 2.5, p = 0.199) and continence (continence rate: 48.4% vs 52.9% (p = 0.763) between the RT-sRP and FT-sRP group. 5-year-BRFS was 60% (RT-sRP) and 68% (FT-sRP, p = 0.849). CONCLUSIONS sRP impacts HRQOL in patients with PCa after RT and FT with no significant differences. Comparison with HRQOL and BRFS of treatment alternatives is paramount to counsel patients for appropriate treatments.
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Affiliation(s)
- Severin Rodler
- Department of Urology, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
| | - Dina Danninger
- Department of Urology, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Lennert Eismann
- Department of Urology, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | | | - Friedrich Jokisch
- Department of Urology, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Minglun Li
- Department of Radiotherapy, Klinikum Lüneburg, Lüneburg, Germany
| | - Armin Becker
- Department of Urology, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Stief
- Department of Urology, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Thilo Westhofen
- Department of Urology, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
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