Would you consider applying the principles of STAMPEDE with <5 oligometastatic non-regional lymph nodes from prostate cancer?

Topics: Radiation Oncology • Genitourinary Cancers

STAMPEDE arm H uses the CHAARTED definition for bone metastases in the axial skeleton. There is no mention of patients with non-regional nodes. Would you offer 55GY/20fx to men with non-regional (common iliac) nodes?

Answer from: Radiation Oncologist at Community Practice

About 25% in STAMPEDE had low volume metastatic disease with no bone Mets, with most having a non-regional node in that category to qualify as low volume Mets.That being said, common iliac could be the primary drainage of prostate cancer based on SNLN studies and I would favor treating like node-pos...

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Radiation Oncologist at Montefiore Med Center AECOM
Would you still treat men with retrocaval/para-aor...

Radiation Oncologist at Varian Medical Systems/Allegheny health network
It is a function of performance status, response t...

Radiation Oncologist at Vanderbilt-Ingram Cancer Center
I would prefer a testing of biology with ADT + NHT...

Answer from: Radiation Oncologist at Community Practice

There isn't "no mention" of non-regional nodal disease in STAMPEDE, nor does one have to extrapolate the principles.From the paper directly: "Low metastatic burden disease is sometimes known as oligometastatic. Although this term is widely used, it is imprecise and potentially misleading because it ...

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Radiation Oncologist at UPMC Hillman Cancer Center
Agree - as @Sushil mentioned above, for these men,...

Answer from: Radiation Oncologist at Community Practice

There was a subset analysis of STAMPEDE (Ali et al., PMID 33599706). They looked at refined definitions of metastases which looked at: bone Mets, visceral Mets, and non-regional nodal disease. Prostate RT had no survival benefit with visceral Mets. It appeared best with 3 or less bone Mets...

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