Top Line: It has become increasingly common in the PSMA PET era to see isolated pelvic or para-aortic lymph node recurrences that are amenable to radiation.
The Study: Several important questions have emerged including: 1) is there a benefit to radiation, 2) should elective nodal volumes also be treated, and 3) what are the adverse effect tradeoffs compared with systemic therapy alone. OLIGOPELVIS 2-GEUTG P12 was a phase 3 trial that assessed the benefits and potential adverse effects of salvage RT with ENI in addition to standard ADT. It included 256 patients who had pelvic or para-aortic lymph node recurrence after prior definitive local therapy. Over half (56%) had received prior RT to either the prostate or prostate fossa. They were randomized to receive ADT with or without radiation to involved nodes (66 Gy in 30 fractions) and elective nodal irradiation (54 Gy in the same 30 fractions). Here we have the initial report comparing early adverse effects between arms. At 6 months, the rates of grade 2+ GU (9.9% v 2.4%) and GI (19.8% v 0%) were significantly higher in the RT arm. These converged over time with no difference in GI AEs at 18 months and a smaller, but still significant difference in GU AEs (10.7% v 4.1%). Of note, receipt of prior prostate or fossa RT was not associated with a higher rate of grade 2+ AEs.
TBL: Not unexpectedly, salvage radiation for pelvic and/or para-aortic lymph node recurrent prostate cancer increased short term grade 2+ GU and GI adverse effects. The big question is whether salvage nodal RT improves treatment outcomes to make the slight increase in AEs worth it. | Corda, Radiother Oncol 2026
The Study: Several important questions have emerged including: 1) is there a benefit to radiation, 2) should elective nodal volumes also be treated, and 3) what are the adverse effect tradeoffs compared with systemic therapy alone. OLIGOPELVIS 2-GEUTG P12 was a phase 3 trial that assessed the benefits and potential adverse effects of salvage RT with ENI in addition to standard ADT. It included 256 patients who had pelvic or para-aortic lymph node recurrence after prior definitive local therapy. Over half (56%) had received prior RT to either the prostate or prostate fossa. They were randomized to receive ADT with or without radiation to involved nodes (66 Gy in 30 fractions) and elective nodal irradiation (54 Gy in the same 30 fractions). Here we have the initial report comparing early adverse effects between arms. At 6 months, the rates of grade 2+ GU (9.9% v 2.4%) and GI (19.8% v 0%) were significantly higher in the RT arm. These converged over time with no difference in GI AEs at 18 months and a smaller, but still significant difference in GU AEs (10.7% v 4.1%). Of note, receipt of prior prostate or fossa RT was not associated with a higher rate of grade 2+ AEs.
TBL: Not unexpectedly, salvage radiation for pelvic and/or para-aortic lymph node recurrent prostate cancer increased short term grade 2+ GU and GI adverse effects. The big question is whether salvage nodal RT improves treatment outcomes to make the slight increase in AEs worth it. | Corda, Radiother Oncol 2026