- 1 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)?
- 2 Evidence summary and recommendations
- 3 References
- 4 Appendices
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. Bleeding (haematuria) responds particularly well. Similar results were found in a more recent case series.
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.
Evidence summary and recommendations
|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||, , , , , , , , |
|Radiotherapy can be considered for palliation of symptoms secondary to locally progressive disease.||D|
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