Phase 2 trial of salvage metastasis-directed therapy versus elective nodal radiotherapy for oligorecurrent nodal prostate cancer metastases

Various locoregional treatments exist for PET-CT detected pelvic nodal oligorecurrences in patients with prostate cancer. The randomized phase 2 PEACE V-STORM trial, at 21 centers in six countries, compared elective nodal radiotherapy (ENRT) to the pelvis versus metastasis-directed therapy (MDT) in this setting. Patients in both groups received 6 months of androgen deprivation therapy. The median follow-up was 50 months (IQR 42-58). The 4-year metastasis-free survival was 63% in the MDT group and 76% in the ENRT group (HR 0.62; 80% CI 0.44-0.86; p=0.063). The most common grade 3 adverse events were urinary incontinence (6% in the MDT group and 10% in the ENRT group) and diarrhea (1% versus 2%). The authors conclude that the trial established ENRT as a potential standard treatment approach for PET-detected nodal recurrences, awaiting a phase 3 trial confirming these results.