Guillaume Ploussard1, Christophe Almeras2, Alberto Briganti3, Gianluca Giannarini4, Christophe Hennequin5, Piet Ost6, Raphaële Renard-Penna7, Ambroise Salin2, Thierry Lebret8, Arnauld Villers9, Michel Soulié10, Alexandre de la Taille11, Vincent Flamand9. 1. Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France; INSERM U955, Team 7, Paris Est University, Créteil, France. Electronic address: g.ploussard@gmail.com. 2. Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France. 3. Unit of Urology, Division of Oncology, Urological Research Institute, Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy. 4. Department of Urology, University of Udine, Udine, Italy. 5. Department of Radiation Oncology, Saint Louis Hospital, Paris 7 University, Paris, France. 6. Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium. 7. Department of Radiology, Pitié Salpétrière Hospital, Paris 6 University, Paris, France. 8. Department of Urology, Foch Hospital, Université Versailles St. Quentin en Yvelines, Suresnes, France. 9. Department of Urology, Lille University Medical Center, Lille University France, Lille, France. 10. Department of Urology, Rangueil Hospital, University of Toulouse, Toulouse, France. 11. Department of Urology, Mondor Hospital, Paris Est University, Créteil, France.
Abstract
PURPOSE: We analyzed all available studies assessing the management of node only recurrence after primary local treatment of prostate cancer. MATERIALS AND METHODS: We systematically reviewed the literature in January 2015 using the PubMed, Web of Sciences and Embase databases according to PRISMA guidelines. Studies exclusively reporting visceral or bone metastatic disease were excluded from analysis. Eight radiotherapy and 12 salvage lymph node dissection series were included in our qualitative study. RESULTS: All 248 radiotherapy and 480 salvage lymph node dissection studies were single arm case series including a total of 728 patients. Choline positron emission tomography/computerized tomography was the reference imaging technique for nodal recurrence detection. Globally 50% of patients remained disease-free after short-term followup. Nevertheless, approximately two-thirds of patients received adjuvant hormone therapy, leading an overestimation of prostate specific antigen-free survival rates obtained after salvage treatment. Combining radiotherapy with salvage lymph node dissection may improve oncologic control in the treated region without improving the outfield relapse risk or the prostate specific antigen response. Great heterogeneity among series in adjuvant treatments, endpoints, progression definitions and study populations made it difficult to assess the precise impact of salvage treatment on the prostate specific antigen response and compare outcomes between radiotherapy and salvage lymph node dissection series. Toxicity after radiotherapy or salvage lymph node dissection was acceptable without frequent high grade complications. The benefit of early hormone therapy as the only salvage treatment remains unknown. CONCLUSIONS: Although a high level of evidence is currently missing to draw any strong conclusion, published clinical series show that in select patients salvage treatment directed to nodal recurrence could lead to good oncologic outcomes. Although the optimal timing of androgen deprivation therapy in this setting is still unknown, such an approach could delay time to systemic treatment with an acceptable safety profile. Future prospective trials are awaited to better clarify this potential impact on well-defined endpoints.
PURPOSE: We analyzed all available studies assessing the management of node only recurrence after primary local treatment of prostate cancer. MATERIALS AND METHODS: We systematically reviewed the literature in January 2015 using the PubMed, Web of Sciences and Embase databases according to PRISMA guidelines. Studies exclusively reporting visceral or bone metastatic disease were excluded from analysis. Eight radiotherapy and 12 salvage lymph node dissection series were included in our qualitative study. RESULTS: All 248 radiotherapy and 480 salvage lymph node dissection studies were single arm case series including a total of 728 patients. Choline positron emission tomography/computerized tomography was the reference imaging technique for nodal recurrence detection. Globally 50% of patients remained disease-free after short-term followup. Nevertheless, approximately two-thirds of patients received adjuvant hormone therapy, leading an overestimation of prostate specific antigen-free survival rates obtained after salvage treatment. Combining radiotherapy with salvage lymph node dissection may improve oncologic control in the treated region without improving the outfield relapse risk or the prostate specific antigen response. Great heterogeneity among series in adjuvant treatments, endpoints, progression definitions and study populations made it difficult to assess the precise impact of salvage treatment on the prostate specific antigen response and compare outcomes between radiotherapy and salvage lymph node dissection series. Toxicity after radiotherapy or salvage lymph node dissection was acceptable without frequent high grade complications. The benefit of early hormone therapy as the only salvage treatment remains unknown. CONCLUSIONS: Although a high level of evidence is currently missing to draw any strong conclusion, published clinical series show that in select patients salvage treatment directed to nodal recurrence could lead to good oncologic outcomes. Although the optimal timing of androgen deprivation therapy in this setting is still unknown, such an approach could delay time to systemic treatment with an acceptable safety profile. Future prospective trials are awaited to better clarify this potential impact on well-defined endpoints.
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