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.
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.
Vargas
Carlos E
CE
Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA. c2002@ufl.edu
Demanes
Jeffrey
J
Boike
Thomas P
TP
Barnaba
Marie-Claire
MC
Skoolisariyaporn
Pat
P
Schour
Lionel
L
Gustafson
Gary S
GS
Gonzalez
Jose
J
Martinez
Alvaro A
AA
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
D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen