The prognostic factors for the recurrence of lymph node (LN) metastasis after dose-escalated radiotherapy (RT) in prostate cancer patients have not been well investigated. We report the prognostic factors and outcomes in patients receiving salvage treatment for LN recurrence after high-dose intensity-modulated RT (IMRT).
We studied a cohort of 419 patients with localized prostate adenocarcinoma undergoing definitive IMRT (78 Gy). LN recurrence was diagnosed by size criteria using computed tomography (CT) or magnetic resonance imaging, or abnormal uptake of (18)F-fluorocholine by LNs on positron emission tomography/CT. Overall survival and LN recurrence-free survival (LNRFS) were calculated, and prognostic factors were evaluated.
With a median follow-up of 60 months, 18 patients (4. 3 %) had LN recurrence and a significantly lower 5-year overall survival rate (60 vs. 90 %, p = 0. 003). Univariate analysis showed that T3/T4 stage (p = 0. 003), Gleason score >7 (p < 0. 001), and estimated risk of pelvic LN involvement of >30 % by the Roach formula (p = 0. 029) were associated with significantly lower LNRFS. On multivariate analysis, high Gleason score (hazard ratio = 5. 99, p = 0. 007) was the only independent factor. The 1/2-year overall survivals after LN recurrence were 67/54 %. Patients with isolated LN recurrence (p = 0. 003), prostate-specific antigen (PSA) doubling time >5 months (p = 0. 009), interval between PSA nadir and biochemical failure >12 months (p = 0. 035), and PSA
Gleason score of >7 may predict LN recurrence in prostate cancer patients treated with definitive IMRT. Small number of patients limits the extrapolation of this risk with the primary treatment strategy. Combined RT and hormones may prolong survival in patients with isolated LN recurrence.
World journal of surgical oncology. 2015 Nov 06*** epublish ***
Yu-Jen Wang, Chao-Yuan Huang, Wei-Hsien Hou, Chia-Chun Wang, Keng-Hsueh Lan, Chung-Hsin Chen, Hong-Jen Yu, Ming-Kuen Lai, Ann-Lii Cheng, Shihh-Ping Liu, Yeong-Shiau Pu, Jason Chia-Hsien Cheng
Department of Radiation Oncology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. Departments of Urology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. Division of Radiation Oncology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. Division of Radiation Oncology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. Division of Radiation Oncology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. Departments of Urology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. Departments of Urology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. Departments of Urology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. Departments of Oncology, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan. Departments of Urology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. Departments of Urology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. Division of Radiation Oncology, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan.