title: Matched-pair analysis of prostate cancer patients with a high risk of positive pelvic lymph nodes treated with and without pelvic RT and high-dose radiation using high dose rate brachytherapy.
abstract: OBJECTIVE
  Adding pelvic radiation to high-dose prostate radiation for prostate cancer patients with a >15% risk of positive lymph nodes (LN) is controversial. We performed a matched-pair analysis of patients treated at 2 institutions to assess the impact of pelvic radiotherapy (P-RT).
  
  
  METHODS
  From January 1993 to March 2003, 2 institutions treated 1432 prostate cancer patients with combined external beam radiotherapy (EBRT) and high-dose rate (HDR) brachytherapy. Those receiving EBRT were treated either to the prostate and seminal vesicles alone or to the entire pelvis (46 Gy). In all cases, prostate dose (EBRT and HDR) resulted in an average BED >100 Gy (alpha/beta = 1.2). There were 755 cases identified as having a pelvic LN risk >15% using the Roach formula. Of these, 255 cases were treated without pelvic RT and randomly matched by Gleason score, T stage, and pretreatment PSA to 500 cases treated with pelvic RT, resulting in 250 pairs (1:1).
  
  
  RESULTS
  Median follow-up was 4.0 years (P = 0.7). The 4-year prostate biochemical failure (22% versus 14%, P = 0.12), distant metastasis (9% versus 4%, P = 0.6), event-free survival (72% versus 78%, P = 0.3), prostate cancer death rate (4% versus 2%, P = 0.9), and overall survival (89% versus 88%, P = 0.7) were not significantly different for patients treated with and without P-RT. Analysis with and without androgen deprivation therapy showed similar results.
  
  
  CONCLUSIONS
  Improved biochemical, clinical, or survival outcomes were not observed for prostate cancer patients at risk for positive pelvic LN >15% when treated with high-dose EBRT and HDR brachytherapy to the prostate with or without pelvic radiation.
authors.affiliation: Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA. c2002@ufl.edu
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Vargas
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Demanes
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Boike
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Barnaba
authors.forename: Pat
authors.initials: P
authors.lastname: Skoolisariyaporn
authors.forename: Lionel
authors.initials: L
authors.lastname: Schour
authors.forename: Gary S
authors.initials: GS
authors.lastname: Gustafson
authors.forename: Jose
authors.initials: J
authors.lastname: Gonzalez
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Martinez
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001918:Brachytherapy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D016555:Matched-Pair Analysis; D015999:Multivariate Analysis; D010388:Pelvis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen