Elective Node Irradiation With Integrated Boost to the Prostate Using Helical IMRT-Clinical Outcome of the Prospective PLATIN-1 Trial.

Stefan Alexander Koerber,Matthias Felix Haefner,Erik Winter,Sonja Katayama,Kai Schubert,Florian Sterzing,Klaus Herfarth,Alla Slynko,Matthias Uhl,Gregor Habl,Juergen Debus

doi:10.3389/fonc.2019.00751

Abstract

Introduction: This prospective, non-randomized phase II trial aimed to investigate the role of additional irradiation of the pelvic nodes for patients with prostate cancer and a high risk for nodal metastases using helical intensity-modulated radiotherapy with daily image guidance (IMRT/IGRT).Methods and materials: Between 2009 and 2012, 40 men with treatment-naïve prostate cancer and a risk of lymph node involvement of more than 20% were enrolled in the PLATIN-1 trial. All patients received definitive, helical IMRT of the pelvic nodes (total dose of 51.0 Gy) with a simultaneous integrated boost (SIB) to the prostate (total dose of 76.5 Gy) in 34 fractions. Antihormonal therapy (AHT) was administered for a minimum of 2 months before radiotherapy continuing for at least 24 months.Results: After a median follow-up of 71 months (range: 5–95 months), pelvic irradiation was associated with a 5-year overall survival (OS) and biochemical progression-free survival (bPFS) of 94.3% and 83.6%, respectively. For our cohort, no grade 4 gastrointestinal (GI) and genitourinary (GU) toxicity was observed. Quality of life (QoL) assessed by EORTC QLQ-C30 questionnaire was comparable to EORTC reference values without significant changes.Conclusion: The current trial demonstrates that elective IMRT/IGRT of the pelvic nodes with SIB to the prostate for patients with a high-risk of lymphatic spread is safe and shows an excellent clinical outcome without compromising the quality of life. The PLATIN-1 trial delivers eminent baseline data for future studies using modern irradiation techniques.

Highlights

This prospective, non-randomized phase II trial aimed to investigate the role of additional irradiation of the pelvic nodes for patients with prostate cancer and a high risk for nodal metastases using helical intensity-modulated radiotherapy with daily image guidance (IMRT/image-guided radiotherapy (IGRT))
Due to an increase of prostatespecific antigen (PSA) levels during NHT, two patients were excluded from the study before radiotherapy
T1 T2 T3 T4 Gleason score, n (%) ≤6 7 ≥8 iPSA [ng/ml], median Risk-group according to d’Amico, n (%) Low Intermediate High Risk of LNI according to Roach formula n (%) >20–40% > 40 % Antihormonal therapy (AHT) 36 months

Summary

Introduction

This prospective, non-randomized phase II trial aimed to investigate the role of additional irradiation of the pelvic nodes for patients with prostate cancer and a high risk for nodal metastases using helical intensity-modulated radiotherapy with daily image guidance (IMRT/IGRT). For dose-escalated irradiation, prostatespecific antigen (PSA) progression was reported in up to 35% of patients with intermediate or high-risk prostate cancer after 5 years [3]. The benefit lost the level of significance with longer follow-up [6]. This trial and several studies using more conventional radiation techniques reported on acute and/ or late gastrointestinal (GI) and genitourinary (GU) toxicities which occurred more frequently compared to POI [7,8,9]. There are some other trials questioning the clinical benefit of WPRT [10, 11]

Methods

Results

Discussion

Conclusion