Adding Androgen Deprivation Therapy + Pelvic Nodal Radiation to Salvage Prostate Bed Radiation Therapy

The June 2022 #RadOnc #JC will focus on addition of ADT and pelvic lymph node radiation treatment to prostate bed salvage radiation.  

The June 18th-19th Journal Club will begin Saturday, June 18th at 8am CST and go through Sunday, June 19th, culminating in the Live Hour from 1-2pm CST Sunday, June 19^th on Twitter Spaces.  

Biochemical failure after salvage prostate bed radiation therapy (PBRT) is typically around 30-50% at 5-10 years, thus there is room for improvement from these suboptimal outcomes. The ARTISTIC meta-analysis recently demonstrated no improvement in event-free survival for adjuvant radiation compared to salvage in men with localized or locally advanced prostate cancer¹. Given these results, most patients should be recommended to have early salvage PBRT when there is a PSA rise after prostatectomy.

In this month’s #RadOnc #JC, we will focus on the NRG Oncology/RTOG 0534 SPPORT phase III trial which was designed to see if incremental improvements could be made through the addition of neoadjuvant and concurrent androgen deprivation therapy (ADT) (which had not yet been tested with salvage PBRT) and pelvic lymph node radiation therapy (PLNRT) (which had never conclusively been proven to be effective in a Phase III randomized clinical trial)². The SPPORT trial randomized patients to PBRT alone at a dose of 64.8–70.2 Gy at 1.8 Gy per fraction daily, PBRT + ADT, or PLNRT (45 Gy at 1.8 Gy per fraction, followed by volume reduction for the remaining 19.8–25.2 Gy) + PBRT + ADT. 

Pollack et al. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial

We are thrilled to be joined by Dr. Alan Pollack (@_APollack) and additional special guests for this month’s #RadOnc #JC 

We are grateful to @TheLancet for making the paper temporarily open access. 

Our guiding topics this month are as follows: 

T1. Background: What data supports the use of ADT in the salvage radiation setting? What data supports the use of pelvic lymph node radiation in addition to radiation to the prostate bed? 

T2. Methods: What were the eligibility criteria? How were the volumes done?  What were the endpoints? 

T3. Results/Discussion: What were the important findings of this trial? How did the outcomes vary between the 3 groups? How did toxicity vary between the 3 groups? What were the limitations of this study?  

T4. #PatientsIncluded: What is important for patients to consider in terms of the 3 different treatment options tested in this study?  What is important when speaking with their radiation oncologists on options including ADT or pelvic lymph node radiation? 

T5. Next steps: How can this trial change treatment recommendations in the salvage prostate radiation setting? What about the role of PET in PLNRT decisions?

Some tips to participate:

• Guidelines on how to sign up & participate
• Disclaimer for ways to keep #RadOnc #JC rewarding and professional. If you’re not ready, just lurk & tune in to the conversation.

References: 

1. Vale CL, Fisher D, Kneebone A, Parker C, Pearse M, Richaud P, Sargos P, Sydes MR, Brawley C, Brihoum M, Brown C, Chabaud S, Cook A, Forcat S, Fraser-Browne C, Latorzeff I, Parmar MKB, Tierney JF; ARTISTIC Meta-analysis Group. Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data. Lancet. 2020 Oct 31;396(10260):1422-1431. doi: 10.1016/S0140-6736(20)31952-8. Epub 2020 Sep 28. PMID: 33002431; PMCID: PMC7611137.
   
    
2. Pollack A, Karrison TG, Balogh AG, Gomella LG, Low DA, Bruner DW, Wefel JS, Martin AG, Michalski JM, Angyalfi SJ, Lukka H, Faria SL, Rodrigues GB, Beauchemin MC, Lee RJ, Seaward SA, Allen AM, Monitto DC, Seiferheld W, Sartor O, Feng F, Sandler HM. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial. Lancet. 2022 May 14;399(10338):1886-1901. doi: 10.1016/S0140-6736(21)01790-6. PMID: 35569466.