Stéphane Supiot1, Loig Vaugier2, David Pasquier3, Xavier Buthaud4, Nicolas Magné5, Didier Peiffert6, Paul Sargos7, Gilles Crehange8, Pascal Pommier9, Genevieve Loos10, Ali Hasbini11, Igor Latorzeff12, Marlon Silva13, Fabrice Denis14, Jean-Léon Lagrange15, Cyrille Morvan16, Loic Campion17, Audrey Blanc-Lapierre17. 1. Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France; Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), UMR 1232 Inserm - 6299 CNRS, Institut de Recherche en Santé de l'Université de Nantes, Nantes Cedex, France. Electronic address: stephane.supiot@ico-unicancer.fr. 2. Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France. 3. Academic Radiation Oncology Department, Centre Oscar Lambret, Lille, France; Centre de Recherche en Informatique, Signal et Automatique de Lille, CRIStAL UMR CNRS 9189, Université de Lille, Lille, France. 4. Department of Radiation Oncology, Centre Catherine de Sienne, Nantes, France. 5. Department of Radiation Oncology, Institut de Cancérologie de la Loire, St Priest en Jarez, France. 6. Department of Radiation Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France. 7. Department of Radiation Oncology, Institut Bergonié, Bordeaux, France. 8. Department of Radiation Oncology, Georges-Francois Leclerc Cancer Center, Dijon, France. 9. Department of Radiation Oncology, Centre Léon Bérard, Lyon, France. 10. Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France. 11. Department of Radiation Oncology, Clinique Pasteur, Brest, France. 12. Department of Radiation Oncology, Oncorad Clinique Pasteur, Toulouse, France. 13. Department of Radiation Oncology, Centre Francois Baclesse, Caen, France. 14. Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France. 15. Department of Radiation Oncology, Hopital Henri Mondor, Créteil, France. 16. Department of Nuclear medicine, Institut de Cancérologie de l'Ouest, Boulevard J. Monod, Nantes, St-Herblain, France. 17. Department of Biostatistics, Institut de Cancérologie de l'Ouest, Boulevard J. Monod, Nantes, St-Herblain, France.
Abstract
BACKGROUND: Oligorecurrent pelvic nodal relapse in prostatic cancer is a challenge for regional salvage treatments. Androgen depriving therapies (ADTs) are a mainstay in metastatic prostate cancer, and salvage pelvic radiotherapy may offer long ADT-free intervals for patients harboring regional nodal relapses. OBJECTIVE: To assess the efficacy of the combination of ADT and salvage radiotherapy in men with oligorecurrent pelvic node relapses of prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: We performed an open-label, phase II trial of combined high-dose intensity-modulated radiotherapy and ADT (6 mo) in oligorecurrent (five or fewer) pelvic node relapses in prostate cancer, detected by fluorocholine positron-emission tomography computed tomography imaging. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was 2-yr progression-free survival defined as two consecutive prostate-specific antigen levels above the level at inclusion and/or clinical evidence of progression as per RECIST 1.1 and/or death from any cause. RESULTS AND LIMITATIONS: Between August 2014 and July 2016, 67 patients were recruited in 15 centers. Half of the patients had received prior prostatic irradiation. The median age was 67.7 yr. After a median follow-up of 49.4 mo, 2- and 3-yr progression-free survival rates were 81% and 58%, respectively. Median progression-free survival was 45.3 mo. The median biochemical relapse-free survival (BRFS) was 25.9 mo. At 2 and 3 yr, the BRFS rates were 58% and 46%, respectively. Grade 2 + 2-yr genitourinary and gastrointestinal toxicities were 10% and 2%, respectively. CONCLUSIONS: Combined high-dose salvage pelvic radiotherapy and ADT appeared to prolong tumor control in oligorecurrent pelvic node relapses in prostate cancer with limited toxicity. After 3 yr, nearly half of patients were in complete remission. Our study showed initial evidence of benefit, but a randomized trial is required to confirm this result. PATIENT SUMMARY: In this report, we looked at the outcomes of combined high-dose salvage pelvic radiotherapy and 6-mo-long hormone therapy in oligorecurrent pelvic nodal relapse in prostatic cancer. We found that 46% of patients presenting with oligorecurrent pelvic node relapses in prostate cancer were in complete remission after 3 yr following combined treatment at the cost of limited toxicity.
BACKGROUND: Oligorecurrent pelvic nodal relapse in prostatic cancer is a challenge for regional salvage treatments. Androgen depriving therapies (ADTs) are a mainstay in metastatic prostate cancer, and salvage pelvic radiotherapy may offer long ADT-free intervals for patients harboring regional nodal relapses. OBJECTIVE: To assess the efficacy of the combination of ADT and salvage radiotherapy in men with oligorecurrent pelvic node relapses of prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: We performed an open-label, phase II trial of combined high-dose intensity-modulated radiotherapy and ADT (6 mo) in oligorecurrent (five or fewer) pelvic node relapses in prostate cancer, detected by fluorocholine positron-emission tomography computed tomography imaging. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was 2-yr progression-free survival defined as two consecutive prostate-specific antigen levels above the level at inclusion and/or clinical evidence of progression as per RECIST 1.1 and/or death from any cause. RESULTS AND LIMITATIONS: Between August 2014 and July 2016, 67 patients were recruited in 15 centers. Half of the patients had received prior prostatic irradiation. The median age was 67.7 yr. After a median follow-up of 49.4 mo, 2- and 3-yr progression-free survival rates were 81% and 58%, respectively. Median progression-free survival was 45.3 mo. The median biochemical relapse-free survival (BRFS) was 25.9 mo. At 2 and 3 yr, the BRFS rates were 58% and 46%, respectively. Grade 2 + 2-yr genitourinary and gastrointestinal toxicities were 10% and 2%, respectively. CONCLUSIONS: Combined high-dose salvage pelvic radiotherapy and ADT appeared to prolong tumor control in oligorecurrent pelvic node relapses in prostate cancer with limited toxicity. After 3 yr, nearly half of patients were in complete remission. Our study showed initial evidence of benefit, but a randomized trial is required to confirm this result. PATIENT SUMMARY: In this report, we looked at the outcomes of combined high-dose salvage pelvic radiotherapy and 6-mo-long hormone therapy in oligorecurrent pelvic nodal relapse in prostatic cancer. We found that 46% of patients presenting with oligorecurrent pelvic node relapses in prostate cancer were in complete remission after 3 yr following combined treatment at the cost of limited toxicity.
Authors: Paul Rogowski; Christian Trapp; Rieke von Bestenbostel; Chukwuka Eze; Ute Ganswindt; Minglun Li; Marcus Unterrainer; Mathias J Zacherl; Harun Ilhan; Leonie Beyer; Alexander Kretschmer; Peter Bartenstein; Christian Stief; Claus Belka; Nina-Sophie Schmidt-Hegemann Journal: Eur J Nucl Med Mol Imaging Date: 2021-10-10 Impact factor: 9.236