A Multi-Institutional Matched-Control Analysis of Adjuvant and Salvage Postoperative Radiation Therapy for pT3-4N0 Prostate Cancer

Trabulsi, Edouard J.; Valicenti, Richard K.; Hanlon, Alexandra L.; Pisansky, Thomas M.; Sandler, Howard M.; Kuban, Deborah A.; Catton, Charles; Michalski, Jeff M.; Zeléfsky, Michael J.; Kupelian, Patrick A.; Lin, Daniel W.; Anscher, Mitchell S.; Slawin, Kevin M.; Roehrborn, Claus G.; Forman, Jeffrey D.; Liauw, Stanley L.; Kestin, Larry L.; DeWeese, Theodore L.; Scardino, Peter T.; Stephenson, Andrew J.; Pollack, Alan

doi:10.1016/j.urology.2008.05.057

Cited by 97 publications

(46 citation statements)

References 23 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5 Patients with favorable characteristics for all five features had a 470% chance of biochemical control 4 years after salvage radiation therapy. 6 The effectiveness of adjuvant radiation therapy in preventing PSA relapse and metastasis has been described in several retrospective 7,8,9 and prospective 10,11 studies, with some studies also attempting to determine factors that would predispose patients to a positive response to adjuvant therapy. [12][13][14] The long-term follow-up of the Southwest Oncology Group adjuvant radiation therapy trial (SWOG 8794/RTOG 9019) with 12-year data 15 16 Given the modest duration of this study's follow-up, the long-term risk of metastatic disease is not yet known.…”

Section: Resultsmentioning

confidence: 99%

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

et al. 2009

View full text Add to dashboard Cite

Prostate cancer is the second most frequently diagnosed cancer in men in the United States. Many men with clinically localized prostate cancer survive for 15 years or more. Although early detection and successful definitive treatments are increasingly common, a debate regarding how aggressively to treat prostate cancer is ongoing because of the effect of aggressive treatment on the quality of life, including sexual functioning. We examined current research on the effect of post-prostatectomy radiation treatment on sexual functioning, and suggest a way in which patient desired outcomes might be taken into consideration while making decisions with regard to the timing of radiation therapy after prostatectomy.

show abstract

Section: Resultsmentioning

confidence: 99%

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

et al. 2009

View full text Add to dashboard Cite

show abstract

“…[10][11][12][13] In one study, adjuvant RT was only found to be beneficial over salvage RT if the side effects were negligible, emphasizing the importance of side effects on treatment timing. 18 In addition, long-term follow-up from the European Organization for Research and Treatment of Cancer (EORTC) trial 22911 has shown that clinical progression-free survival rates previously reported with adjuvant RT were no longer clinically significant; moreover, in patients over 70, adjuvant RT had a detrimental effect on progression-free and overall survival.…”

Section: Complications Of Radiotherapy After Prostatectomymentioning

confidence: 99%

“…2,4,5 Salvage RT, performed later and triggered by biochemical recurrence, has been shown to be beneficial in several retrospective analyses. [6][7][8][9] Although the results of retrospective trials comparing adjuvant and salvage RT favour adjuvant RT, [10][11][12][13] no prospective randomized trials have been completed. The timing of postoperative RT remains controversial and treatment toxicity should be one of the factors considered.…”

Section: Introductionmentioning

confidence: 99%

Long-term complications in men who have early or late radiotherapy after radical prostatectomy.

Sowerby

Gani²,

Yim³

et al. 2014

CUAJ

View full text Add to dashboard Cite

Introduction: Choosing adjuvant radiotherapy (RT) or salvage RT after radical prostatectomy (RP) for locally advanced prostate cancer is controversial. Performing RT early after RP may increase the risk of urinary complications compared to RT performed later. We evaluated the urinary complication rates of men treated with surgery followed by early or late RT. Methods: Using a retrospective chart review, we compared rates of urinary incontinence (UI), bladder neck contracture (BNC), or urethral stricture in men with prostate cancer treated with early RT (<6 months after RP) or late RT (≥6 months after RP), 3 years after RT. Results: In total, 652 patients (between 2000 and 2007) underwent early RT (162,24.8%) or late RT (490, 75.2%) after RP. The mean time to early RT was 3.6 months (range: 1-5 months) and to late RT was 30.1 months (range: 6-171 months). At 3 years post-RT, UI rates were similar in the early RT and the late RT groups (24.5% vs. 23.3%, respectively, p = 0.79). Prior to RT, 27/652 (4%) patients had a BNC and 11/652 (1.7%) had a urethral stricture, of which only 1 BNC persisted at 3 years post-RT. After RT, 17/652 (2.6%) BNC and 4/652 (0.6%) urethral stricture developed; of these, 6 BNC and 2 urethral strictures persisted at 3 years. Conclusion: Rates of UI, BNC, and urethral stricture were similar with early and late RT at 3 years post-RT. These findings suggest that the timing of RT after RP does not alter the incidences of these urinary complications and can aid in the decision-making process regarding adjuvant RT versus salvage RT.

show abstract

“…[10][11][12] However, this question (and the question of the optimal duration of adjuvant androgen deprivation therapy) is currently being tested in the intergroup RCT RADICALS which is open in more than 20 centres across Canada. Patients with any high-risk features should be considered for this trial.…”

Section: Andrew Loblaw MD Frcpcmentioning

confidence: 99%

Opportunity lost and found: Any easy way to improve outcomes for prostate cancer patients in the postoperative setting?

Loblaw¹

2013

CUAJ

View full text Add to dashboard Cite

E vidence-based medicine is a paradigm shift and is a key component in the provision of high-quality care. The highest quality evidence is clinical practice guidelines based on systematic reviews of the randomized controlled trial (RCT) literature. There are many challenges to successfully complete RCTs and it is problematic to synthesize recommendations when the RCTs have conflicting results.However, in the case of the utility of adjuvant postoperative radiotherapy (ART), this is not the case. There are three RCTs showing improvements in local and biochemical control; 1-3 the study with the longest follow-up (SWOG 8794) also demonstrates improvements in distant metastatic disease-free survival and overall survival. 2 Cancer Care Ontario (CCO) published a systematic review of the literature and clinical practice guideline on the topic showing that all subgroups benefitted in biochemical control and overall survival from ART (and those with seminal vesicle involvement seemed to benefit more not less). 4 It is very interesting to see how this evidence is applied in the pragmatic setting. In this issue of CUAJ, Tyldesley and colleagues have published a population-based analysis of postoperative radiotherapy in British Columbia from 2007 to 2009. 5 Many interesting facts are reported. Over the 3-year observation period, 9223 patients were identified from the tumour registry and linked to centralized radiotherapy records. Of these patients, initial therapy was radical prostatectomy in 24%. Postoperatively, 47% had one or more highrisk features (positive surgical margin: 36%; extracapsular spread: 22%; seminal vesicle involvement: 4%). 5 Of the 47% with one or more high-risk features, 23% with any adverse features were seen by a radiation oncologist within 6 months of surgery. Only 10% of these patients received adjuvant ART (i.e., 2% of patients with any highrisk features). Of equal interest, 40% of those with adverse features who were seen were advised against ART.Why are the rates of referral (23%) and recommendation (60%) and use of ART (2%) so low for these patients?The first argument is a lack of knowledge. The EORTC and SWOG studies were published in 2005 and 2006, respectively (and all were presented in abstract before the observation period). Despite this, we know that evidence takes a while to diffuse into practice, particularly community practice. How long is too long when we have a treatment with a solid evidence base that improves not just biochemical, but distant metastatic disease and overall survival rates? Is there anything we could have done differently to accelerate this knowledge dissemination?The second argument is that the treatment is too toxic. It is easy to attribute really bad side effects (such as severe hemorrhagic cystitis) to all patients who might get radiation. However, when prospectively collected, the data demonstrate that the risk of serious RT toxicity was low. In the Wiegel trial, 1% and 0% of patients had grade 3 bladder and bowel problems. 3 This is despite patients receiving 2-d...

show abstract

A Multi-Institutional Matched-Control Analysis of Adjuvant and Salvage Postoperative Radiation Therapy for pT3-4N0 Prostate Cancer

Cited by 97 publications

References 23 publications

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

Counseling patients about sexual health when considering post-prostatectomy radiation treatment

Long-term complications in men who have early or late radiotherapy after radical prostatectomy.

Opportunity lost and found: Any easy way to improve outcomes for prostate cancer patients in the postoperative setting?

Contact Info

Product

Resources

About