What is the evidence for the effect of radiotherapy in palliation of soft tissue disease of EBRT to the prostate for symptom treatment in locally advanced disease and to local metastases (such as the lymph nodes for symptom treatment such as lymphoedema and painful lymph nodes)?

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What is the evidence for the effect of radiotherapy in palliation of soft tissue disease of EBRT to the prostate for symptom treatment in locally advanced disease and to local metastases (such as the lymph nodes for symptom treatment such as lymphoedema and painful lymph nodes)?

Treatment of loco-regionally progressive disease (lymph and prostate)

The vast majority of patients with hormone-resistant prostatic carcinoma present with symptomatic bony metastases as their major symptom. There is a subset of patients, however, who present with significant pelvic symptoms (obstructive urinary symptoms, bleeding, rectal obstruction, pelvic and rectal pain) relating to locally progressive disease with or without symptomatic bony disease. The median survival of these men with small-volume distant disease can be around 18–24 months and 6–12 months in those with more extensive disease. The optimal management of these patients remains far from clear. There are no randomised studies addressing the role of pelvic radiotherapy. However a number of retrospective studies suggest that a fractionated course of high-dose palliative pelvic radiation treatment can be extremely useful in obtaining growth restraint and alleviating the symptoms arising from the disease process.[1][2][3][4][5][6][7][8][9] Bleeding (haematuria) responds particularly well. Similar results were found in a more recent case series.[10]

A small subset of patients can also present with significant metastatic nodal disease within the pelvis, abdomen, chest and supraclavicular or lower neck region. The enlarged nodes can result in significant pain or obstructive symptoms due to the extrinsic compression on the adjacent organs. No randomised or retrospective studies have specifically addressed the role of radiation treatment in this setting. It is unlikely that any such studies will be undertaken.

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Evidence summary and recommendations

Evidence summary Level References
Although there are no randomised prospective trials to address whether radiotherapy has a beneficial effect on incurable prostate cancer and its soft tissue metastases, the question of benefit remains clinically important. Therefore, nine case series have been reviewed noting that these all pertain to locally advanced prostate cancer. There were no significant publications reviewing soft tissue metastases. IV [1], [2], [3], [4], [5], [6], [7], [8], [9]
Evidence-based recommendationQuestion mark transparent.png Grade
Radiotherapy can be considered for palliation of symptoms secondary to locally progressive disease.
D


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References

  1. 1.0 1.1 Carlton CE Jr, Dawoud F, Hudgins P, Scott R Jr. Irradiation treatment of carcinoma of the prostate: a preliminary report based on 8 years of experience. J Urol 1972 Dec;108(6):924-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/5082749.
  2. 2.0 2.1 Kraus PA, Lytton B, Weiss RM, Prosnitz LR. Radiation therapy for local palliative treatment of prostatic cancer. J Urol 1972 Oct;108(4):612-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/4119657.
  3. 3.0 3.1 Green N. Value of radiotherapy for adenocarcinoma of the prostate simulating primary rectal carcinoma. J Urol 1974 Aug;112(2):247-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/4135605.
  4. 4.0 4.1 Megalli MR, Gursel EO, Demirag H, Veenema RJ, Guttman R. External radiotherapy in ureteral obstruction secondary to locally invasive prostatic cancer. Urology 1974 May;3(5):562-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/4830631.
  5. 5.0 5.1 Michigan S, Catalona WJ. Ureteral obstruction from prostatic carcinoma: response to endocrine and radiation therapy. J Urol 1977 Nov;118(5):733-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/916091.
  6. 6.0 6.1 Fosså SD. Palliative pelvic radiotherapy in patients with hormone-resistant prostatic cancer. Prog Clin Biol Res 1987;243B:479-85 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2443925.
  7. 7.0 7.1 Kynaston HG, Keen CW, Matthews PN. Radiotherapy for palliation of locally advanced prostatic carcinoma. Br J Urol 1990 Nov;66(5):515-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1701107.
  8. 8.0 8.1 Perez CA, Cosmatos D, Garcia DM, Eisbruch A, Poulter CA. Irradiation in relapsing carcinoma of the prostate. Cancer 1993 Feb 1;71(3 Suppl):1110-22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7679040.
  9. 9.0 9.1 Furuya Y, Akakura K, Akimoto S, Ichikawa T, Ito H. Radiotherapy for local progression in patients with hormone-refractory prostate cancer. Int J Urol 1999 Apr;6(4):187-91 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10226836.
  10. Hindson B, Turner S, Do V. Palliative radiation therapy for localized prostate symptoms in hormone refractory prostate cancer. Australas Radiol 2007 Dec;51(6):584-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17958697.

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Appendices