Comparison of adjuvant versus salvage radiotherapy policies for postprostatectomy radiotherapy

Hagan, Michael P.; Zlotecki, Robert A.; Medina, Camillo; Tercilla, Oscar F.; Rivera, Inoel; Wajsman, Zev

doi:10.1016/j.ijrobp.2003.11.038

Cited by 50 publications

(37 citation statements)

References 39 publications

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“…These findings are consistent with those of other retrospective studies reported in the literature. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]20,22 Recently, a large randomized trial of more than 1000 patients was published with findings similar to ours, although followup to date is only 5 years. 2 It is possible that with longer follow-up, a survival advantage attributed to the use of adjuvant RT will emerge.…”

Section: Discussionsupporting

confidence: 75%

“…For patients at high risk of local failure, that is, those with positive surgical margins, adjuvant radiotherapy (RT) results in permanent local control in the majority of patients. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Whether adjuvant RT offers an advantage in survival or reduces deaths from prostate cancer compared to radiation delivered at the time of prostate-specific antigen (PSA) recurrence remains unknown. The majority of studies, which address this issue, are small, retrospective and suffer from short follow-up.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Timing and patterns of recurrences and deaths from prostate cancer following adjuvant pelvic radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate

Anscher

Clough

Robertson

et al. 2006

Prostate Cancer Prostatic Dis

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To determine the timing and patterns of late recurrence after radical prostatectomy (RP) alone or RP plus adjuvant radiotherapy (RT). Between 1970 and 1983, 159 patients underwent RP for newly diagnosed adenocarcinoma of the prostate and were found to have positive surgical margins, extracapsular extension and/or seminal vesicle invasion. Of these, 46 received adjuvant RT and 113 did not. The RT group generally received 45-50 Gy to the whole pelvis, then a boost to the prostate bed (total dose of 55-65 Gy). In the RP group, 62% received neoadjuvant/adjuvant androgen deprivation vs 17% in the RT group. Patients were analyzed with respect to timing and patterns of failure. Only one patient was lost to follow-up. The median follow-up for surviving patients was nearly 20 years. The median time to failure in the surgery group was 7.5 vs 14.7 years in the RT group (P ¼ 0.1). Late recurrences were less common in the surgery group than the RT group (9 and 1% at 10 and 15 years, respectively vs 17 and 9%). In contrast to recurrences, nearly half of deaths from prostate cancer occurred more than 10 years after treatment. Deaths from prostate cancer represented 55% of all deaths in these patients. Recurrences beyond 10 years after RP in this group of patients were relatively uncommon. Despite its long natural history, death from prostate cancer was the most common cause of mortality in this population with locally advanced tumors, reflecting the need for more effective therapy.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Timing and patterns of recurrences and deaths from prostate cancer following adjuvant pelvic radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate

Anscher

Clough

Robertson

et al. 2006

Prostate Cancer Prostatic Dis

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“…Other retrospective studies compared aRT and sRT with better results than BPFS in aRT patients [26,27] . On the other hand, the same results for aRT and sRT have also been published [28] . A low pretreatment PSA level is an important factor for sRT to be successful.…”

Section: Discussionsupporting

confidence: 61%

Radical Prostatectomy in High-Grade Prostate Cancer, Salvage and Adjuvant Radiotherapy

Broďák

Košina²,

Holub³

et al. 2010

Urol Int

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Introduction: Prostate cancer with a Gleason score (GS) of 8–10 is linked to a higher risk of recurrence and progression. The aim of this paper is to evaluate treatment results of our high-risk patient cohort.Patients and Methods: The cohort of 42 patients with radical prostatectomy (RP) specimen histology GS 8–10 was assessed. The patients were followed up after RP and radiotherapy (RT) was delivered in case of a biochemical relapse. Adjuvant radiotherapy (aRT) was delivered only in case of a positive surgical margin (PSM). The following parameters were evaluated: biochemical progression-free survival (BPFS), overall survival (OS) and cancer-specific survival (CSS). The second objective was to evaluate adverse effects of RP and RT. Results: The median follow-up time was 88 months (18–168). RP led to BPFS in 16 patients (38%). Five patients with PSM underwent aRT and 20 underwent salvage radiotherapy (sRT). One patient died of myocardial infarction and 1 patient died of metastatic disease. Skeletal metastases were recorded in 2 patients. The BPFS in RP combinations with sRT or aRT was reached in 29 patients (69%). The OS and CSS in our cohort reached 95 and 98%, respectively. Conclusion: Management with aRT only in PSM was very effective, according to our retrospective study.

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“…[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

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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.

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Comparison of adjuvant versus salvage radiotherapy policies for postprostatectomy radiotherapy

Cited by 50 publications

References 39 publications

Timing and patterns of recurrences and deaths from prostate cancer following adjuvant pelvic radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate

Timing and patterns of recurrences and deaths from prostate cancer following adjuvant pelvic radiotherapy for pathologic stage T3/4 adenocarcinoma of the prostate

Radical Prostatectomy in High-Grade Prostate Cancer, Salvage and Adjuvant Radiotherapy

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

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