Abstract
The benefit of elective nodal irradiation (ENI) in combination with androgen deprivation therapy in high risk localized node negative prostate cancer has yet to be clearly defined. The potential gains in local control have been offset by the increased toxicity associated with pelvic radiotherapy, and recognition that historically the only trials to demonstrate a survival advantage in this group have been with androgen deprivation therapy. This review article considers the impact of pivotal randomized clinical trials conducted over the last thirty years on routine clinical practice, and how modern techniques may help to redefine radiotherapy as a necessary component for this group of patients.
Highlights
The clinical benefit of elective pelvic nodal irradiation (ENI) in the management of prostate cancer remains controversial and as yet unproven
Concerns have been raised with the increased gastrointestinal toxicity associated with pelvic radiotherapy, with questionable gains in overall survival over and above that of long term androgen deprivation therapy (ADT), which has long been considered the mainstay of treatment for advanced prostate cancer
The results showed that when administered with NHT, there was improved progression-free survival (PFS) with whole pelvic (WP) compared with prostate only (PO) radiation fields (PFS: 60% v 44% at 4 years, respectively; p = 0.008) and improved prostate-specific antigen (PSA) relapse-free survival (70% vs 57% at 4 years, respectively; p = 0.048)
Summary
The clinical benefit of elective pelvic nodal irradiation (ENI) in the management of prostate cancer remains controversial and as yet unproven. Concerns have been raised with the increased gastrointestinal toxicity associated with pelvic radiotherapy, with questionable gains in overall survival over and above that of long term androgen deprivation therapy (ADT), which has long been considered the mainstay of treatment for advanced prostate cancer. The question of pelvic radiotherapy is gaining renewed interest in high risk node negative prostate cancer especially as there is increasing supportive data for the use ADT with prostate and pelvic radiotherapy in the management of node positive disease [1] [2] [3]. This review article considers the data from selected randomized controlled studies addressing the question of pelvic radiotherapy in high risk node negative disease, together with the optimum duration of ADT
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