title: Toxicity and quality of life after choline-PET/CT directed salvage lymph node dissection and adjuvant radiotherapy in nodal recurrent prostate cancer.
abstract: BACKGROUND
  In a previous study we demonstrated that, based on 11C/18 F-choline positron emission tomography-computerized-tomography as a diagnostic tool, salvage lymph node dissection (LND) plus adjuvant radiotherapy (ART) is feasible for treatment of pelvic/retroperitoneal nodal recurrence of prostate cancer (PCa). However, the toxicity of this combined treatment strategy has not been systematically investigated before. The aim of the current study was to evaluate the acute and late toxicity and quality of life of ART after LND in pelvic/retroperitoneal nodal recurrent PCa.
  
  
  METHODS
  43 patients with nodal recurrent PCa were treated with 46 LND followed by ART (mean 49.6 Gy total dose) at the sites of nodal recurrence. Toxicity of ART was analysed by physically examination (31/43, 72.1%), by requesting 15 frequent items of adverse events from the Common-Terminology-Criteria for Adverse Events Version 4.0-catalogue and by review of medical records. QLQ-C30 (EORTC quality of life assessment) and PR25 (prostate cancer module) questionnaires were used to investigate quality of life. Toxicity was evaluated before starting of ART, during ART (acute toxicity), after ART (mean 2.3 months) and at end of follow up (mean 3.2 years after end of ART) reflecting late toxicity.
  
  
  RESULTS
  71.7% (33/46) of 46 ART were treatment of pelvic, 10.9% (5/46) of retroperitoneal only and 28.3% (13/46) of pelvic and retroperitoneal regions. Overall 52 symptoms representing toxicities were observed before ART, 107 during ART, 88 after end of ART and 52 at latest follow up. Leading toxicities during ART were diarrhoea (19%, 20/107), urinary incontinence (16%, 17/107) and fatigue (16%, 17/107). The spectrum of late toxicities was almost equal to those before beginning of ART. No grade 3 adverse events or chronic lymphedema at extremities were observed. We observed no clear correlation between localisation of treated regions, technique of ART and frequency or severity of toxicities. Mean quality of life at final evaluation was 74%.
  
  
  CONCLUSIONS
  ART after extended LND in PCa relapse is justifiable with respect to adverse effects and toxicity. The side effects were circumscribed and well tolerated. The spectrum of adverse events at latest follow up was almost equal to those before start of ART.
authors.forename: Cordula A
authors.initials: CA
authors.lastname: Jilg
authors.forename: Anja
authors.initials: A
authors.lastname: Leifert
authors.forename: Daniel
authors.initials: D
authors.lastname: Schnell
authors.forename: Simon
authors.initials: S
authors.lastname: Kirste
authors.forename: Natalia
authors.initials: N
authors.lastname: Volegova-Neher
authors.forename: Daniel
authors.initials: D
authors.lastname: Schlager
authors.forename: Gesche
authors.initials: G
authors.lastname: Wieser
authors.forename: Karl
authors.initials: K
authors.lastname: Henne
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schultze-Seemann
authors.forename: Anca-L
authors.initials: AL
authors.lastname: Grosu
authors.affiliation: Department of Radiation Oncology, Albert-Ludwigs University of Freiburg, Robert-Koch-Str, 3, 79106 Freiburg, Germany. hans.christian.rischke@uniklinik-freiburg.de.
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Rischke
mesh_terms: D000368:Aged; D002250:Carbon Radioisotopes; D002794:Choline; D005462:Fluorine Radioisotopes; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D011788:Quality of Life; D019275:Radiopharmaceuticals; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D002794:Choline
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