Extended-field radiation therapy for prostatic carcinoma with para-aortic lymph node metastasis

Area of Science:

• Oncology
• Radiation Oncology
• Urologic Oncology

Background:

• Para-aortic lymph node involvement in prostate cancer historically indicates a poor prognosis, often limiting treatment to palliative care.
• The potential for cure or long-term progression-free survival in patients with regional metastasis confined to infra-diaphragmatic lymph nodes remains an area of investigation.

Purpose of the Study:

• To evaluate the efficacy of aggressive treatment, specifically extended field radiation therapy, in patients with adenocarcinoma of the prostate and metastasis to para-aortic lymph nodes.
• To determine the proportion of patients who may achieve cure or long-term progression-free survival with this aggressive approach.

Main Methods:

• A cohort of 114 patients with clinical Stage III adenocarcinoma of the prostate were treated with curative intent between June 1970 and March 1983.
• Twenty-three patients with confirmed para-aortic lymph node metastasis received aggressive external radiation therapy to the pelvis and para-aortic region.
• Median doses administered were 70 Gy to the prostate, 54 Gy to the pelvis, and 50 Gy to the para-aortic region, with a median follow-up of 53.5 months.

Main Results:

• Actuarial survival at 5 years was 90%, and progression-free survival at 5 years was 73%.
• The rate of major complications associated with the treatment was 4.3%.
• These outcomes suggest a significant benefit from the aggressive treatment strategy.

Conclusions:

• Extended field radiation therapy can lead to prolonged progression-free survival in patients with adenocarcinoma of the prostate and juxtaregional lymph node dissemination.
• This aggressive treatment approach may offer a potential for cure in a subset of these patients.
• Despite the small patient numbers, the data support the consideration of extended field radiation therapy for selected cases.