Adjuvant radiotherapy versus wait-and-see strategy for pathologic T3 or margin-positive prostate cancer: A meta-analysis.

Abstract

19 Background: Optimal management after radical prostatectomy (RP) remains controversial in patients with pathologic T3 or margin-positive prostate cancer with the options being early adjuvant radiotherapy (ART) versus wait-and-see (WS). Methods: A comprehensive Medline search to identify randomized controlled trial (RCT) of ART vs WS was done. Synthesized results from the included studies show Metastasis-Free Survival (MFS) and overall survival (OS) rates at 10 years as well as Grade 2 or greater GI and GU toxicities in the studies. Results were based on the random-effect (RE) model if there was evidence of between-trial heterogeneity, otherwise the fixed-effect (FE) model was used. Results: A total of 3 RCTs (ARO9602/AUO AP09/95, EORTC22911, SWOG8794) were identified with 1,737 patients (ART: n=864, WS: n=873). 10-year estimates of MFS and OS rates were reported for SWOG and EORTC studies, and estimated for ARO 96-02/AUO AP09/95 study from their Kaplan-Meier curves (Table). Pooled 10-year MFS data showed a significant improvement with ART vs WS (OR= 0.77; 95% CI 0.62–0.96, p=0.02, FE). However, pooled 10-year OS was not significantly different (OR= 0.98; 95% CI 0.64–1.49, p=0.91, RE). Grade 2 or greater GI toxicity was reported by all three studies and was significantly higher in ART (2.5%) compared with WS (1.1%), p=0.04. Grade 2 or greater GU toxicity was reported by ARO9602 and EORTC studies and was significantly higher in ART (17.1%) compared with WS (10.3%), p=0.0004. Conclusions: 10-year MFS is significantly improved with ART compared with WS. No benefit in 10-year OS was found. Grade 2 or greater GI and GU toxicities where greater in ART compared with WS. [Table: see text]

Role of robot‐assisted radical prostatectomy in locally advanced prostate cancer

“…However, whether adjuvant RT or wait‐and‐see strategy has been discussed. Meta‐analysis showed adjuvant RT results in greater benefits of biochemical progression‐free survival, clinical progression‐free survival, hormone‐free survival and 10‐year metastasis‐free survival in comparison with a wait‐and‐see strategy, there is no difference in OS . In contrast, adjuvant RT showed significantly increased genitourinary toxicity, urinary stricture rates and urinary incontinence.…”

Novel imaging techniques for intraoperative margin assessment in surgical oncology: A systematic review

“…[2][3][4][5][6][7] Furthermore, inadequate margins put patients at risk of undergoing additional therapy, that is, re-resection or adjuvant (chemo) radiotherapy, which is associated with increased morbidity, reduced quality of life and costs. [8][9][10][11][12][13][14][15][16][17][18][19] Despite the burden on patients and the healthcare system, inadequate margins continue to occur frequently in around 5% of resections of lung 4 and kidney 20 tumors, in 15% to 20% of resections of breast, 2 prostate 21 and rectal 6 cancer and in up to 40% and 60% of resections of vulvar 22 and oral 5 cancer.…”