• Clin Transl Radiat Oncol · May 2020

    Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancer.

    • C P Liskamp, M L Donswijk, H G van der Poel, E E Schaake, and W V Vogel.
    • Department of Radiation Oncology, NKI-AVL, Amsterdam, The Netherlands.
    • Clin Transl Radiat Oncol. 2020 May 1; 22: 9-14.

    PurposeBiochemical failure after external beam radiotherapy (RT) for node-positive prostate cancer (PCN+) frequently involves nodal recurrences, in most cases out of field. This raises the question if current RTOG-based elective nodal fields can still be considered optimal. Modern diagnostic tools like PSMA PET/CT and choline PET/CT can visualize nodal recurrences with unprecedented accuracy. We evaluated recurrence patterns on PET/CT after RT for PCN+, with the aim to explore options for improved nodal target definition.Methods And MaterialsData of all patients treated with curative intent EBRT for PCN+ in NKI-AVL from 2008 to 2018 were retrospectively reviewed. EBRT comprised 70 Gy to the prostate or 66-70 Gy to the prostate bed, 60 Gy to involved nodes, and 52,5-56 Gy (46 Gy EQD2) to RTOG-based elective nodal fields, in 35 fractions. Locations of recurrences on PET/CT were noted, and nodal locations were correlated with the applied EBRT fields.Results42 patients received PSMA (28) or choline (14) PET/CT at biochemical recurrence. 35 patients (83%) had a positive scan. At their first positive scan 17 patients had nodal metastasis, in some cases together with a local recurrence or distant disease. In-field nodal recurrences were uncommon (n = 3). Out-field nodal recurrences occurred more frequently (n = 14), with the majority (n = 12) just above the elective nodal field. These nodes were the single area of detectable failure in 6 patients (14%).ConclusionsCurrent RT with RTOG-based nodal fields for PCN+ provides good in-field tumour control, but frequent out-field nodal recurrences suggest missed microscopic locations. Expanding elective fields to include the aorta bifurcation may prolong recurrence-free survival. Future research must address whether the potential benefits of this strategy outbalance additional toxicity.© 2020 The Author(s).

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