A multi-institutional analysis comparing adjuvant and salvage radiation therapy for high-risk prostate cancer patients with undetectable PSA after prostatectomy

Budiharto, Tom; Perneel, Christiaan; Haustermans, Karin; Junius, S.; Tombal, Bertrand; Scalliet, Pierre; Renard, Laurette; Lerut, Evelyne; Vekemans, K.; Joniau, Steven; Poppel, Hendrik Van

doi:10.1016/j.radonc.2010.07.008

Cited by 35 publications

(14 citation statements)

References 29 publications

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“…First, just 11.7% of patients with pT3/4 N0/1 disease received RT within 6 months from surgery in the current cohort. This proportion is significantly lower compared with the rates seen in institutional series, where it ranged between 35 and 60% . Theoretically, the majority of patients included in the present study should have received adjuvant RT, according to contemporary guidelines .…”

Section: Discussioncontrasting

confidence: 55%

Early radiotherapy after radical prostatectomy improves cancer‐specific survival only in patients with highly aggressive prostate cancer: Validation of recently released criteria

et al. 2014

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Abbreviations & Acronyms ADT = androgen deprivation therapy ARR = absolute risk reduction CCI = Charlson Comorbidity Index CI = confidence interval CSM = cancer-specific mortality eRT = early radiotherapy HR = hazard ratio ICD-O = International Classification of Disease for Oncology LNI = lymph node invasion NNT = number needed to treat PCa = prostate cancer PSM = positive surgical margins RP = radical prostatectomy RT = radiotherapy SEER = Surveillance, Epidemiology, and End Results Correspondence Objectives:To test the effect of radiotherapy administered within 6 months after radical prostatectomy on cancer-specific mortality in prostate cancer patients after stratification according to a risk score. Methods: Overall, 7616 patients with pT3/4 N0/1 prostate cancer treated with radical prostatectomy between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included in the study. Competing-risks regression models were carried out to test the effect of early radiotherapy on cancer-specific mortality in the entire cohort, and after stratifying patients according to the risk score based on the number and nature of adverse pathological characteristics (Gleason score 8-10; pT3b/4, lymph node invasion). Results: The risk score was associated with increasing 5-and 10-year cancer-specific mortality rates (P < 0.001). When considering only patients with a risk score ≥ 2, 5-and 10-year cancer-specific mortality rates were significantly lower for individuals undergoing early radiotherapy compared with their counterparts not receiving early radiotherapy (2.9 and 6.9 vs 5.7 and 16.2%, respectively; P = 0.002). The corresponding number required to treat to prevent one death from prostate cancer at 10-year follow up was 10. Early radiotherapy was not associated with lower cancer-specific mortality rates overall and in patients with a risk score <2. This was confirmed in multivariable analyses, where early radiotherapy decreased the risk of cancer-specific mortality only in patients with a risk score ≥ 2 (P ≤ 0.02). Conclusions: The presence of two or more of the following pathological features might be used to identify patients who benefit from early radiotherapy: Gleason score 8-10, pT3b/4 and lymph node invasion.

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Section: Discussioncontrasting

confidence: 55%

Early radiotherapy after radical prostatectomy improves cancer‐specific survival only in patients with highly aggressive prostate cancer: Validation of recently released criteria

et al. 2014

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“…All studies were full-text articles [2], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]. Examination of the references listed for these studies and for the review articles did not yield any further studies for evaluation.…”

Section: Resultsmentioning

confidence: 99%

“…Among the included studies, there was no RCT between ART and SRT. Two retrospective studies were matched in a 1∶1 ratio according to preoperative prostate-specific antigen Gleason score, seminal vesicle invasion, surgical margin status, and follow-up from date of surgery [38], [39] (level of evidence: 3a); and 9 retrospective studies were retrospective studies compared high-risk series of patients (level of evidence: 3b) [2], [27], [30], [31], [32], [34], [35], [36], [41], [42]; 7 retrospective studies used no distinction between risk series of patients (level of evidence: 4) [25], [26], [28], [29], [33], [37], [40].…”

Section: Resultsmentioning

confidence: 99%

Adjuvant and Salvage Radiotherapy after Prostatectomy: A Systematic Review and Meta-Analysis

et al. 2014

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PurposeIn men with adverse prognostic factors (APFs) after radical prostatectomy (RP), the most appropriate timing to administer radiotherapy remains a subject for debate. We conducted a systemic review and meta-analysis to evaluate the therapeutic strategies: adjuvant radiotherapy (ART) and salvage radiotherapy (SRT).Materials and MethodsWe comprehensively searched PubMed, EMBASE, Web of Science and the Cochrane Library and performed the meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the prognostic factors of ART and SRT.ResultsBetween May 1998 and July 2012, 2 matched control studies and 16 retrospective studies including a total of 2629 cases were identified (1404 cases for ART and 1185 cases for SRT). 5-year biochemical failure free survival (BFFS) for ART was longer than that for SRT (Hazard Ratio [HR]: 0.37; 95% CI, 0.30–0.46; p<0.00001, I2 = 0%). 3-year BFFS was significantly longer in the ART (HR: 0.38; 95% CI, 0.28–0.52; p<0.00001, I2 = 0%). Overall survival (OS) was also better in the ART (RR: 0.53; 95% CI, 0.41–0.68; p<0.00001, I2 = 0%), as did disease free survival (DFS) (RR: 0.53; 95% CI, 0.43–0.66; p<0.00001, I2 = 0%). Exploratory subgroup analysis and sensitivity analysis revealed the similar results with original analysis.ConclusionART therapy offers a safe and efficient alternative to SRT with longer 3-year and 5-year BFFS, better OS and DFS. Our recommendation is to suggest ART for patients with APFs and may reduce the need for SRT. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update this analysis.

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“…An advantage from ART for bNED and local control was claimed in numerous studies [56][57][58]59 & ,60,61]. It has been argued that correcting for overtreated ART patients will annihilate the benefit of adjuvant over salvage radiotherapy [62].…”

Section: Adjuvant Radiotherapy Vs Salvage Radiotherapymentioning

confidence: 99%

Adjuvant radiotherapy or early salvage radiotherapy in pT3R0 or pT3R1 prostate cancer

Bartkowiak

Bottke²,

Wiegel³

2013

Current Opinion in Urology

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A multi-institutional analysis comparing adjuvant and salvage radiation therapy for high-risk prostate cancer patients with undetectable PSA after prostatectomy

Cited by 35 publications

References 29 publications

Early radiotherapy after radical prostatectomy improves cancer‐specific survival only in patients with highly aggressive prostate cancer: Validation of recently released criteria

Early radiotherapy after radical prostatectomy improves cancer‐specific survival only in patients with highly aggressive prostate cancer: Validation of recently released criteria

Adjuvant and Salvage Radiotherapy after Prostatectomy: A Systematic Review and Meta-Analysis

Adjuvant radiotherapy or early salvage radiotherapy in pT3R0 or pT3R1 prostate cancer

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