Dose Escalation for Patients with Decreasing PSA during Radiotherapy for Elevated PSA after Radical Prostatectomy Improves Biochemical Progression-Free Survival

Siegmann, Alessandra; Bottke, Dirk; Faehndrich, Julia; Lohm, Gunnar; Miller, Kurt; Bartkowiak, Detlef; Wiegel, Thomas; Hinkelbein, W.

doi:10.1007/s00066-011-2229-3

Cited by 35 publications

(10 citation statements)

References 33 publications

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“…In retrospect, the results were better than achieved in a cohort that, irrespective of response, was treated with 66.6 Gy. While a superiority of 70 Gy over 66 Gy can not be postulated based on these data because of the selection bias inherent to the selection process for dose escalation, these data nevertheless confirm the potential of SRT in patients with localized, radiosensitive disease [13,18]. …”

Section: Discussionmentioning

confidence: 85%

“…Although PSRM at RP have been demonstrated to be an important predictor of disease recurrence [12], they have also been associated with improved bRFS after SRT, with a patient with positive margins who relapses being more likely to benefit from SRT targeting the pelvic/prostate-bed tissues than a patient with negative margins, whose PSA failure possibly represents distant disease [10,13]. …”

Section: Discussionmentioning

confidence: 99%

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Dose-escalated salvage radiotherapy after radical prostatectomy in high risk prostate cancer patients without hormone therapy: outcome, prognostic factors and late toxicity

et al. 2013

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PurposeEvaluation of dose escalated salvage radiotherapy (SRT) in patients after radical prostatectomy (RP) who had never received antihormonal therapy. To investigate prognostic factors of the outcome of SRT and to analyze which patient subsets benefit most from dose escalation.Materials and methodsBetween 2002 and 2008, 76 patients were treated in three different dose-groups: an earlier cohort treated with 66 Gy irrespective of pre-RT-characteristics and two later cohorts treated with 70 Gy or 75 Gy depending on pre-RT-characteristics. Biochemical-relapse-free-survival (bRFS), clinical-relapse-free-survival (cRFS) and late toxicity were evaluated.ResultsFour-year bRFS and cRFS were 62.5% and 85%. Gleason score <8, positive surgical resection margin (PSRM) and low PSA (≤0.5 ng/ml) before SRT resulted in higher bRFS. Analysis of the whole group showed no clear dose-outcome relationship. Patients with PSRM, however, had improved bRFS when escalating >66 Gy. While > 70 Gy did not improve the overall results, 4-year bRFS for patients with manifest local recurrence in the high-dose group was still comparable to those without manifest local recurrences. No grade 4 and minimal grade 3 gastrointestinal and urinary toxicity were observed.ConclusionsDose-escalated SRT achieves high biochemical control. The data strongly support the application of at least 70 Gy rather than 66 Gy. They do not prove positive effects of doses >70 Gy but do not disprove them as these doses were only applied to an unfavorable patients selection.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Dose-escalated salvage radiotherapy after radical prostatectomy in high risk prostate cancer patients without hormone therapy: outcome, prognostic factors and late toxicity

et al. 2013

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“…In their letter, Dr. Gadhjar et al criticize selection bias in our SRT study [4], but do not offer in what respect the selection was flawed. They point out correctly that in our retrospective analysis, the PSA response during SRT was unknown for "early" patients and state that the selection favored the high-dose cohort.…”

Section: Response By a Siegmann 1 D Bottke 2 J Faehndrich 1 mentioning

confidence: 93%

Letter to the Editor on: A. Siegmann et al. Dose Escalation for Patients with Decreasing PSA during Radiotherapy for Elevated PSA after Radical Prostatectomy Improves Biochemical ProgressionFree Survival. Results of a Retrospective Study

Ghadjar

Wiegel

2011

Strahlenther Onkol

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“…With 3D conformal radiotherapy, a dose escalation (66.6 vs. 72 Gy) was beneficial for treatment responders, whose PSA had started to decrease during the course of radiation [32]. Using intensity modulated (IMRT) and image guide (IGRT) radiotherapy even 76 Gy was administered safely, as judged by acute and long-term toxicity [33,34].…”

Section: 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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Dose Escalation for Patients with Decreasing PSA during Radiotherapy for Elevated PSA after Radical Prostatectomy Improves Biochemical Progression-Free Survival

Abstract: Our analysis suggests that patient selection during SRT for a dose escalation to 70.2 Gy can improve the freedom from biochemical progression in patients with SRT after RP.

Cited by 35 publications

References 33 publications

Dose-escalated salvage radiotherapy after radical prostatectomy in high risk prostate cancer patients without hormone therapy: outcome, prognostic factors and late toxicity

Dose-escalated salvage radiotherapy after radical prostatectomy in high risk prostate cancer patients without hormone therapy: outcome, prognostic factors and late toxicity

Letter to the Editor on: A. Siegmann et al. Dose Escalation for Patients with Decreasing PSA during Radiotherapy for Elevated PSA after Radical Prostatectomy Improves Biochemical ProgressionFree Survival. Results of a Retrospective Study

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

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