Headline: Elective nodal radiation for prostate cancer is making a comeback from behind.
The Study: The SPORRT trial enrolled nearly 1800 men with biochemical recurrence status-post prostatectomy. As a reminder, there were three arms: [1] prostate bed radiation, [2] prostate-bed radiation + ADT, and [3] whole pelvis radiation + ADT. Dose to the prostate bed was 64.8-70.2 Gy across all arms, elective nodes received 45 Gy in arm 3, and ADT when given began 2 months prior to radiation for a total of 4-6 months. Reporting of the third interim analysis (LBA5) including nearly 1200 men assessing the primary outcome of progression-free survival demonstrated pretty clear separations at 5 years: [1] 71%, [2] 83%, and [3] 89%. There was a similar trend with rates of distant mets, producing impressive hazard ratios, though number of events were low: [1] 8%, [2] 6%, and [3] 4%. While intriguing, per usual prostate cancer data maturation has been outpaced by technology, and it’s hard to say how this all applies to visible recurrences on newer PET scans.
Bottom Line: The SPORRT trial supports previous high-level data that ADT improves outcomes with salvage radiation, and elective nodal coverage probably makes sense without radiographic localization of disease. | Pollack, ASTRO 2018


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