What criteria do you use in deciding whether or not to treat the pelvis in prostate cancer?
NRG/RTOG 0924 - The end of elective nodal RT in localized prostate cancer?
Top line results:
NRG/RTOG 0924 is a very large phase III randomized trial powered for overall survival (OS) to determine if there is a benefit of the addition of whole pelvic radiotherapy (WPRT) to prostate RT plus ADT. This...
The literature is compelling (as summarized by Dr. @Dr. First Last) that for many high-risk patients, and likely all unfavorable intermediate-risk patients, WPRT is unnecessary.
That said, I will gripe that stating "The end of elective nodal RT in localized prostate cancer" is overselling things a li...
It’s interesting that in PEACE V, elective nodal volume treatment in nodal recurrence did improve regional recurrence as well as metastasis-free survival compared to INRT. So it may be a function of the risk of microscopic disease in the pelvis. PEACE-2 for very high risk done in the modern era with...
There may be no issue in radiation oncology more controversial than elective nodal irradiation (ENI) in prostate cancer. If we knew, we wouldn’t currently have 0924 open, which is the largest study ever attempted by the RTOG, this time powered for 10-year OS (target accrual = 2,580). Since we actual...
Regarding the putative efficacy of ENI, could the nodal template be an issue regarding the trials mentioned? Consider the PSMA/PET patterns of failure by Schiller et al., PMID 32451312.
I always let the patient decide.
I review the accuracy of an MRI, CT, and PET for detecting lymph nodes.
I then review the idea behind the MSKCC nomogram followed by the low pelvic failure rates despite a high prediction rate Zumsteg et al., PMID 26165583.
We then cover the ability to salvage pelvic fa...