"After curative treatment of localized prostate cancer (PCa), up to 50% of the patients with high-risk disease can experience a biochemical relapse {1}. Restaging by modern metabolic imaging modalities allows visualization of clinical relapse at very low prostate specific antigen (PSA) levels, with the majority of the patients harboring an oligorecurrent disease, defined as up to 3 or 5 lesions, mainly located in the pelvis {2–4}."
"The aim of this systematic review is to present the rationale and the results of the different RT strategies for nodal recurrence treatment and then to compare them in an effort to improve the management of nodal oligorecurrent hormone-sensitive PCa by defining the optimal target volume of salvage RT treatments."
See the Full Text, Figure, and summary Table.Radiotherapy treatment volumes for oligorecurrent nodal prostate cancer: a systematic review (2020, Review, Full Text)
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Abstract
Background: Radiotherapy is an emerging treatment strategy for nodal oligorecurrent prostate cancer (PCa) patients. However, large heterogeneities exist in the RT regimens used, with series reporting the use of elective nodal radiotherapy (ENRT) strategies and others the delivery of focal treatments to the relapsing nodes with Stereotactic Body Radiotherapy (SBRT). In this systematic review of the literature we compared the oncological outcomes and toxicity of the different RT regimens for nodal oligorecurrent PCa patients, with the aim of defining the optimal RT target volume in this setting.
Methods: We performed a systemic search on the Pubmed database to identify articles reporting on the use of ENRT or SBRT for oligometastatic PCa with nodal recurrence.
Results: Twenty-two articles were analyzed, including four prospective phase II trials (3 with SBRT and 1 with ENRT). Focal SBRT, delivered with an involved node, involved site, and involved field modality, was the most commonly used strategy with 2-year progression-free survival (PFS) rates ranging from 16 to 58% and a very low toxicity profile. Improved PFS rates were observed with ENRT strategies (52–80% at 3 years) compared to focal SBRT, despite a slightly higher toxicity rate. One ongoing randomized phase II trial is comparing both modalities in patients with nodal oligorecurrent PCa.Conclusions: With a large variability in patterns of practice, the optimal RT strategy remains to be determined in the setting of nodal oligorecurrent PCa. Ongoing randomized trials and advances in translational research will help to shed light on the best management for these patients."
[Emphasis mine]
Djin