Salvage Radiotherapy Combined With Hormonotherapy in Oligometastatic Pelvic Node Relapses of Prostate Cancer

• Hormonotherapy

Hormone therapy is recommended Eligard 45 mg acting for 6 months. It will be ideally administered the day of start of radiation therapy or within 3 months before the first day of radiotherapy.

Nevertheless, free prescription is left to investigators. When using other hormonal strategies (anti-androgen agonists, LHRH antagonists or LHRH), an administration for six months will be critical.

• Radiotherapy

Conformational Radiotherapy techniques in Intensity-Modulated (IMRT)

2.1) Doses prescribed

• PTV1 PTV5 to 66 Gy in 30 fractions of 2.2 Gy
• PTV Pelvis: 54 Gy in 30 fractions of 1.8 Gy
• PTV Loge 60 Gy in 30 fractions of 2 Gy 6 Gy A complement of 3 in two additional fractions Gy may be delivered across the lodge PTV.
• PTV Relapse Lodge: In addition to treating the PTV Lodge, additional radiation of 6 Gy in 3 fractions of 2 Gy may be made to bring the total dose of 72 Gy in 36 fractions of 2 Gy.

2.2) Treatment

Radiation Guided by a picture (IGRT) will be performed daily. This daily recalibration will be based at least on bone structures. It will be possible to readjust the nodal structures.

Inclusion criteria

• Histologically proven adenocarcinoma of the prostate
• Patients aged 18 years or more
• PS 0-1
• Previous radical treatment to the prostate (radiotherapy or surgery)
• PSA increase of at least 3 assays in the same laboratory over the last 12 months.
• 1-5 pelvic lymph node metastases detected with 18FCH-PET. A relapse in the dressing prostatectomy is associated possible.
• Upper limit of lymph node metastases: aortic bifurcation
• Respect dosimetric constraints to organs at risk
• Treatment with hormone therapy may be started before inclusion, to a maximum of three months prior to Day 1 of radiotherapy. This hormone will necessarily be preceded by a free interval treatment of at least 6 months since the last injection, by adding the duration of action of this predictable injection (1, 3 or 6 months)
• Patient affiliated to a social security scheme
• Patient Information and written informed consent form signed

Exclusion criteria

• bone or visceral metastatic relapse associated
• para-aortic nodal relapse (the upper limit is tolerated aortic bifurcation)
• more than 5 lymph node metastases
• Proof of metastases at initial diagnosis
• Evidence of distant metastases in the pelvic lymph nodes or outside the prostate bed
• prior pelvic lymph nodes Irradiation. Irradiation of the bed of the prostate is not an exclusion criterion, but the junction between prior irradiation bed prostatectomy and radiation field pelvic lymph nodes should be examined carefully
• castration resistance defined by clinical or biochemical progression despite a combined androgen blockade
• known contraindications to pelvic irradiation (eg, chronic inflammatory bowel disease, ...)
• known contraindications to hormone therapy, according to standard recommendations in force
• serious Hypertension not controlled by appropriate treatment
• Other concomitant cancer or history of cancer (within 5 years prior to study entry), except basal cell or squamous cell carcinomas of the skin.
• Patient with a psychological, familial, sociological or geographical potentially hampering compliance with the study protocol and follow-up schedule
• Patient already included in another interventional study involving the approval of a CPP during his screening for the study OLIGOPELVIS
• Private person of liberty or major trust