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Salvage Lymph Node Dissection with Adjuvant Radiotherapy for Nodal Recurrence of Prostate Cancer

2012; Lippincott Williams & Wilkins; Volume: 188; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2012.08.041

1527-3792

Cordula A. Jilg, Hans Christian Rischke, S. N. Reske, Karl Henne, Anca‐Ligia Grosu, Wolfgang Weber, Vanessa Drendel, M. Schwardt, Anett Jandausch, Wolfgang Schultze‐Seemann,

Advanced Radiotherapy Techniques

No AccessJournal of UrologyAdult Urology1 Dec 2012Salvage Lymph Node Dissection with Adjuvant Radiotherapy for Nodal Recurrence of Prostate Cancer C.A. Jilg, H.C. Rischke, S.N. Reske, K. Henne, A.-L. Grosu, W. Weber, V. Drendel, M. Schwardt, A. Jandausch, and W. Schultze-Seemann C.A. JilgC.A. Jilg Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany , H.C. RischkeH.C. Rischke Department of Nuclear Medicine, Albert-Ludwigs University of Freiburg, Freiburg, Germany Department of Radiotherapy, Albert-Ludwigs University of Freiburg, Freiburg, Germany , S.N. ReskeS.N. Reske Department of Nuclear Medicine, University Ulm, Ulm, Germany , K. HenneK. Henne Department of Radiotherapy, Albert-Ludwigs University of Freiburg, Freiburg, Germany , A.-L. GrosuA.-L. Grosu Department of Radiotherapy, Albert-Ludwigs University of Freiburg, Freiburg, Germany , W. WeberW. Weber Department of Nuclear Medicine, Albert-Ludwigs University of Freiburg, Freiburg, Germany , V. DrendelV. Drendel Department of Pathology, Albert-Ludwigs University of Freiburg, Freiburg, Germany , M. SchwardtM. Schwardt Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany , A. JandauschA. Jandausch Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany , and W. Schultze-SeemannW. Schultze-Seemann Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany View All Author Informationhttps://doi.org/10.1016/j.juro.2012.08.041AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the impact of salvage lymph node dissection with adjuvant radiotherapy in patients with nodal recurrence of prostate cancer. By default, nodal recurrence of prostate cancer is treated with palliative antihormonal therapy, which causes serious side effects and invariably leads to the development of hormone refractory disease. Materials and Methods: A total of 47 patients with nodal recurrence of prostate cancer based on evidence of 11C-choline/18F-choline (18F-fluorethylcholine) positron emission tomography-computerized tomography underwent primary (2 of 52), secondary (45 of 52), tertiary (4 of 52) and quaternary (1 of 52) salvage lymph node dissection with histological confirmation. Of 52 salvage lymph node dissections 27 were followed by radiotherapy. Biochemical response was defined as a prostate specific antigen less than 0.2 ng/ml after salvage therapy. The Kaplan-Meier method, binary logistic regression and Cox regression were used to analyze survival as well as predictors of biochemical response and clinical progression. Results: Mean prostate specific antigen at salvage lymph node dissection was 11.1 ng/ml. A mean of 23.3 lymph nodes were removed per salvage lymph node dissection. Median followup was 35.5 months. Of 52 salvage lymph node dissections 24 resulted in complete biochemical response followed by 1-year biochemical recurrence-free survival of 71.8%. Gleason 6 or less (OR 7.58, p = 0.026), Gleason 7a/b (OR 5.91, p = 0.042) and N0 status at primary therapy (OR 8.01, p = 0.011) were identified as independent predictors of biochemical response. Gleason 8–10 (HR 3.5, p = 0.039) as a preoperative variable, retroperitoneal positive lymph nodes (HR 3.76, p = 0.021) and incomplete biochemical response (HR 4.0, p = 0.031) were identified as postoperative predictors of clinical progression. Clinical progression-free survival was 25.6% and cancer specific survival was 77.7% at 5 years. Conclusions: Based on 11C/18F-choline positron emission tomography-computerized tomography as a diagnostic tool, salvage lymph node dissection is feasible for the treatment of nodal recurrence of prostate cancer. Most patients experience biochemical recurrence after salvage lymph node dissection. 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Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPloussard G, Almeras C, Briganti A, Giannarini G, Hennequin C, Ost P, Renard-Penna R, Salin A, Lebret T, Villers A, Soulié M, de la Taille A and Flamand V (2015) Management of Node Only Recurrence after Primary Local Treatment for Prostate Cancer: A Systematic Review of the LiteratureJournal of Urology, VOL. 194, NO. 4, (983-988), Online publication date: 1-Oct-2015.Tilki D, Mandel P, Seeliger F, Kretschmer A, Karl A, Ergün S, Seitz M and Stief C (2014) Salvage Lymph Node Dissection for Nodal Recurrence of Prostate Cancer after Radical ProstatectomyJournal of Urology, VOL. 193, NO. 2, (484-490), Online publication date: 1-Feb-2015.Karnes R, Murphy C, Bergstralh E, DiMonte G, Cheville J, Lowe V, Mynderse L and Kwon E (2014) Salvage Lymph Node Dissection for Prostate Cancer Nodal Recurrence Detected by 11C-Choline Positron Emission Tomography/Computerized TomographyJournal of Urology, VOL. 193, NO. 1, (111-116), Online publication date: 1-Jan-2015.Jilg C, Schultze-Seemann W, Drendel V, Vach W, Wieser G, Krauss T, Jandausch A, Hölz S, Henne K, Reske S, Grosu A, Weber W and Rischke H (2014) Detection of Lymph Node Metastasis in Patients with Nodal Prostate Cancer Relapse Using 18F/11C-Choline Positron Emission Tomography/Computerized TomographyJournal of Urology, VOL. 192, NO. 1, (103-111), Online publication date: 1-Jul-2014.Taneja S (2013) Re: Early Salvage Radiation Therapy Combined with Short-Term Hormonal Therapy in Recurrent Prostate Cancer After Radical Prostatectomy: Single-Institution 4-Year Data on Outcome, Toxicity, Health-Related Quality of Life and Co-Morbidities from 184 Consecutive Patients Treated with 70 GyJournal of Urology, VOL. 189, NO. 6, (2107-2108), Online publication date: 1-Jun-2013.Steers W (2012) This Month in Adult UrologyJournal of Urology, VOL. 188, NO. 6, (2029-2030), Online publication date: 1-Dec-2012. Volume 188Issue 6December 2012Page: 2190-2197 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordsrecurrenceprostatic neoplasmslymph node excisionsalvage therapypositron-emission tomography and computed tomographyMetricsAuthor Information C.A. Jilg Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany More articles by this author H.C. Rischke Department of Nuclear Medicine, Albert-Ludwigs University of Freiburg, Freiburg, Germany Department of Radiotherapy, Albert-Ludwigs University of Freiburg, Freiburg, Germany More articles by this author S.N. Reske Department of Nuclear Medicine, University Ulm, Ulm, Germany More articles by this author K. Henne Department of Radiotherapy, Albert-Ludwigs University of Freiburg, Freiburg, Germany More articles by this author A.-L. Grosu Department of Radiotherapy, Albert-Ludwigs University of Freiburg, Freiburg, Germany More articles by this author W. Weber Department of Nuclear Medicine, Albert-Ludwigs University of Freiburg, Freiburg, Germany More articles by this author V. Drendel Department of Pathology, Albert-Ludwigs University of Freiburg, Freiburg, Germany More articles by this author M. Schwardt Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany More articles by this author A. Jandausch Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany More articles by this author W. Schultze-Seemann Department of Urology, Albert-Ludwigs University of Freiburg, Freiburg, Germany More articles by this author Expand All Advertisement PDF downloadLoading ...