To retrospectively analyze outcomes of patients who received definitive pelvic irradiation for clinically pelvic node-positive (cT1-4N1M0) prostate cancer (PCa).
Clinical records of 148 patients with cT1-4N1M0 PCa treated with definitive pelvic radiotherapy (RT) between 2011 and 2015 were retrospectively collected from 25 institutions by the Japanese Radiation Oncology Study Group. The median age, initial prostate-specific antigen (PSA) level, and biologically effective dose (BED) to the prostate with α/β of 1.5 Gy were 69 (interquartile range [IQR], 65-74.3) years, 41.5 (IQR, 20.3-89) ng/ml, and 177.3 (IQR, 163.3-182) Gy, respectively. All patients underwent neoadjuvant androgen-deprivation therapy (ADT) for a median duration of 10 months. Most patients (141; 95.2%) received concurrent ADT during the irradiation period. The median duration of adjuvant ADT was 16 (IQR, 5-27.8) months. The Phoenix definition was used to assess biochemical failure.
The median follow-up period was 53.5 months (IQR, 41-69.3). The 5-year overall survival (OS) probability was 86.8%. The 5-year biochemical failure-free survival and clinical progression-free survival rates were 69.6% and 76.3%, respectively. Multivariate analysis indicated the BED to the prostate to be a significant prognostic factor for OS. Regarding late adverse events, the estimated cumulative incidences of late Grade 2 or higher gastrointestinal and genitourinary toxicities at 5 years were 8.2% and 5.8%, respectively.
Long-term ADT combined with definitive pelvic external beam RT for cT1-4N1M0 PCa leaded to favorable outcomes. Future prospective studies should validate the suggested survival benefit of local dose escalation to the prostate in this cohort.
Journal of radiation research. 2025 Mar 07 [Epub ahead of print]
Toshiya Maebayashi, Takashi Mizowaki, Hitoshi Ishikawa, Kiyonao Nakamura, Koji Inaba, Hirofumi Asakura, Hiromitsu Iwata, Satoshi Itasaka, Hiroyuki Wada, Masakuni Sakaguchi, Keiichi Jingu, Takeshi Akiba, Natsuo Tomita, Katsumasa Nakamura, Japanese Radiation Oncology Study Group
Department of Radiology, Nihon University School of Medicine, 30-1, Ooyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan., Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan., Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-7 Anagawa, Inage, Chiba 263-8555, Japan., Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan., Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan., Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan., Department of Radiation Oncology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan., Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8471, Japan., Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan., Department of Radiation Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan., Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan., Department of Radiation Oncology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu city, Shizuoka 431-3192, Japan.