What is the efficacy of radiation for locally advanced node positive disease?

From Cancer Guidelines Wiki

What is the efficacy of radiation for locally advanced node positive disease?

External beam radiotherapy

There are three randomised control trials examining radiotherapy alone as a treatment option for node-positive disease. Two of the three trials compared prostate and pelvic irradiation to para-aortic and pelvic and prostate irradiation.[1][2][3] The Bagshaw trial included 18 patients and the Pilepich trial, a subgroup analysis, included 134 patients. The third trial was also small, with 77 patients. It compared extended field radiation in pelvic lymphadenectomy patients with observation followed by delayed hormonal therapy.[4]None of the trials was blinded. There were no RCTs comparing conformal modern radiotherapy techniques with immediate hormone therapies.

The trials examining extended field with a more limited pelvic field were consistent, showing no overall survival or disease-free survival benefit when comparing extended para-aortic irradiation to pelvic and prostate irradiation. There was only one trial comparing radiotherapy with no radiotherapy.[4] At five years median disease-free survival was statistically significantly improved in the radiotherapy arm. However, the overall survival benefit with radiotherapy was not statistically significant. The lack of statistical significance may be due to limited follow-up.

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Evidence summary and recommendations

Evidence summary Level References
The role of external beam radiotherapy in node-positive patients has not yet been defined. II [1], [2], [3], [4]
Evidence-based recommendationQuestion mark transparent.png
There is insufficient evidence to make a recommendation for the use of external beam

radiation as alternative or adjuvant to hormone therapies in node-positive patients.


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References

  1. 1.0 1.1 Pilepich MV, Krall JM, Johnson RJ, Sause WT, Perez CA, Zinninger M, et al. Extended field (periaortic) irradiation in carcinoma of the prostate--analysis of RTOG 75-06. Int J Radiat Oncol Biol Phys 1986 Mar;12(3):345-51 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3514555.
  2. 2.0 2.1 Pilepich MV, Krall JM, Sause WT, Johnson RJ, Russ HH, Hanks GE, et al. Correlation of radiotherapeutic parameters and treatment related morbidity in carcinoma of the prostate--analysis of RTOG study 75-06. Int J Radiat Oncol Biol Phys 1987 Mar;13(3):351-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3494005.
  3. 3.0 3.1 Bagshaw MA. Radiotherapeutic treatment of prostatic carcinoma with pelvic node involvement. Urol Clin North Am 1984 May;11(2):297-304 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/6428023.
  4. 4.0 4.1 4.2 Paulson DF, Cline WA Jr, Koefoot RB Jr, Hinshaw W, Stephani S. Extended field radiation therapy versus delayed hormonal therapy in node positive prostatic adenocarcinoma. J Urol 1982 May;127(5):935-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/6806486.

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Appendices