Felipe Couñago, National Clinical Director of GenesisCare Spain, shared on LinkedIn:
“Just published in Clinical Oncology!
Should we routinely irradiate the elective pelvic lymph nodes in high-risk localized prostate cancer?
Our systematic review and meta-analysis brings together all phase III randomized evidence, including 5 trials and 5,172 patients, complemented by a reconstructed individual-patient-data analysis.
Key findings:
- Whole-pelvis radiotherapy (WPRT) did not improve overall survival compared with prostate-only radiotherapy (HR 1.07; 95% CI 0.94–1.21).
- The apparent benefit in biochemical/progression-free and metastasis-free survival was driven by a single PSMA-staged, single-centre trial (POP-RT).
- When this trial was excluded, the progression benefit disappeared.
- WPRT modestly increased late ≥G2 GU and GI toxicity, without a meaningful excess of severe events.
Take-home message: current randomized evidence does not support routine elective pelvic irradiation in unselected patients with high-risk localized prostate cancer.
Importantly, POP-RT raises the possibility that a carefully selected subgroup of very-high nodal-risk, PSMA-staged patients could benefit , a hypothesis that deserves prospective validation.
Huge congratulations and thanks to all co-authors for the outstanding teamwork and collaboration!”
Title: Whole-pelvic versus prostate-only radiotherapy in clinically node-negative high-risk localised prostate cancer: a systematic review and meta-analysis with reconstructed individual-patient data
Authors: José Daniel Subiela, Elías Gomis Sellés, Fernando López Campos, Júlia Aumatell, Daniel Antonio González-Padilla, Álvaro Gonzalo Balbás, David López-Curtis, Victoria Vera Barragán, Jorge Caño-Velasco, Natalia Picola Brau, Pedro de Pablos-Rodríguez, Juan Gómez Rivas, Luis San-José Manso, Francisco Javier Burgos Revilla, Francesco Barletta, Filippo Alongi, Constantinos Zamboglou, Luca Nicosia, Mohamed Shelan, Antonio-José Conde-Moreno, Pablo Gajate, Patricia Guerrero, Òscar Buisan, Felipe Couñago
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