Surgical staging in carcinoma of the prostate: the RTOG experience. Radiation Therapy Oncology Group

One hundred thirty-six patients with carcinoma of the prostate entered on phase III RTOG studies (RTOG 75-06 and RTOG 77-06) between 1976 and the end of 1980 underwent staging lymphadenectomy prior to irradiation. The operative reports and histological findings have been reviewed in order to determine the patterns of intrapelvic tumor spread and to correlate the type of surgical procedure and the extent of lymphatic dissection with the incidence and type of postirradiation complications (primarily genital and lower extremity lymphedema). The surgical procedures were classified into three categories according to extent: 1) biopsy only, 2) limited (diagnostic) dissection, and 3) complete (therapeutic) dissection. The incidence of postirradiation lymphedema was found to be strongly dependent upon the extent of dissection. Patients undergoing limited (diagnostic) dissection followed by pelvic irradiation have a 25-30% risk of developing this debilitating complication. In patients undergoing complete (therapeutic) dissection followed by pelvic irradiation lymphedema has been observed in 66% of cases.