Outcome Of Elective Nodal Radiation In Elderly Patients With High Risk Prostate Cancer

Abstract

The role of pelvic lymph-node irradiation in prostate cancer remains controversial. Nevertheless, it is agreed that for ‘high-risk’ disease standard therapy should remain prostate and pelvic radiotherapy with extended period of androgen suppression. In the UK there is some reluctance to using pelvic irradiation due to the risk of acute and late bowel toxicities. In clinical practice patients are often older with comorbidities which may impact treatment outcome quality of life. Retrospective analyses of all patients aged 70 years or older treated with pelvic nodal irritation at our institute between January 2015 to September 2018. iSOFT manager for used for clinical data and MOSAIQ for radiotherapy parameters. Statistical analysis was performed using Stata version 11.2 72 patients were identified. Median age was 73.6 years (range of 70 to 83). 88% have pT3 or grater disease. Median PSA was 78.4 (IQ range 2.4 – 209). 51% had node positive disease. All patients were treated with at least 3 months of neoadjuvant endocrine treatment before starting radiotherapy (range 3-8 months). All patients were treated with 74 Gy in 37 fractions using IMRT technique .84% patients were given 55 Gy to pelvic nodes and remaining 16% were given nodal dose up to 64 Gy( 10% received 60 Gy and 6% 64 Gy respectively).After median follow up of 27 months( IQ range 14-58 months), 12% had biochemical recurrence and 2 patients had metastatic disease. Grade 3 bowel toxicities were documented in 5% cases and 18% patients had grade 2 or above urinary toxicities. No grade 4 gastrointestinal (GI) and genitourinary (GU) toxicity was observed. Our study demonstrates that elective IMRT of the pelvic nodes for elderly patients with a high-risk of lymphatic spread is safe and shows an excellent clinical outcome without compromising the quality of life.