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Postoperative Pelvic Lymph Node Radiation Therapy in Lymph Node-Positive Prostate Cancer and Mortality Risk.

Mutlay Sayan1, Yetkin Tuac2, Markus Graefen3

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Summary
This summary is machine-generated.

Including whole-pelvic radiotherapy (WPRT) in prostate cancer treatment after surgery significantly reduces mortality risks for node-positive patients. This approach, compared to prostate bed radiotherapy alone, offers improved survival outcomes in prostate cancer management.

Keywords:
Pelvic lymph node radiationProstate bed radiotherapyProstate cancer

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Clinical Urology

Background:

  • Uncertainty exists regarding the impact of including pelvic lymph nodes in radiotherapy (RT) volumes for node-positive prostate cancer (PC) patients post-radical prostatectomy (RP).
  • Assessing the association between whole-pelvic lymph node RT (WPRT) and prostate bed RT (PBRT) versus PBRT alone on mortality is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To evaluate the association of whole-pelvic lymph node RT (WPRT) plus prostate bed RT (PBRT) with all-cause mortality (ACM) and PC-specific mortality (PCSM) compared to PBRT alone.
  • To determine if WPRT impacts survival outcomes in patients with pathologically node-positive (pN1) prostate cancer after RP.

Main Methods:

  • Retrospective analysis of 816 patients with pT2-4pN1M0 PC treated with RP and postoperative RT.
  • Multivariable Cox and Fine-Gray regression models were used to compare WPRT + PBRT versus PBRT alone.
  • Adjustments were made for multiple clinical and pathological variables, including age, PSA, Gleason score, and lymph node status.

Main Results:

  • The addition of WPRT to PBRT was associated with a significant reduction in ACM risk (adjusted hazard ratio [AHR], 0.30; p < .001).
  • WPRT was also linked to a significantly reduced PCSM risk (AHR, 0.42; p = .03) compared to PBRT alone.
  • Median follow-up was 4.83 years, with notable limitations including the study's retrospective design and evolving therapies.

Conclusions:

  • Whole-pelvic radiotherapy (WPRT) is associated with lower risks of all-cause and PC-specific mortality in node-positive prostate cancer patients receiving postoperative RT.
  • These findings suggest that WPRT may be a beneficial addition to standard treatment for selected patients.
  • Further investigation in prospective studies is warranted to confirm these survival benefits.