Early and late toxicity profiles of patients receiving immediate postoperative radiotherapy versus salvage radiotherapy for prostate cancer after prostatectomy

Vogel, Marco M. E.; Kessel, Kerstin A.; Gschwend, Jürgen E.; Weichert, Wilko; Wilkens, Jan J.; Combs, Stephanie E.

doi:10.1007/s00066-018-1359-2

Cited by 5 publications

(8 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients receiving ART, that never might have relapsed, are exposed to possible toxicities and side effects caused by RT. In an earlier publication [18], we showed, that patients with immediate postoperative RT compared to SRT experience significantly higher rates of early gastrointestinal toxicities as proctitis, as well as early genitourinary side effects as urinary tract obstruction. Hence, the decision between ART or PSA-based follow-up and potential SRT should also be based on the patients’ postoperative clinical condition and any risk factors, as well as the patients’ preference.…”

Section: Discussionmentioning

confidence: 99%

“…First results are expected in 2021. We previously reported data on toxicity in a patient cohort comparing immediate postoperative RT versus SRT [18]. In the present article we evaluate the oncological outcome after ART compared to SRT in the same cohort to answer the question whether SRT is equieffective to ART in terms of oncological outcome.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy

et al. 2019

Self Cite

View full text Add to dashboard Cite

BackgroundAdjuvant (ART) and salvage radiotherapy (SRT) are two common concepts to enhance biochemical relapse free survival (BCRFS) in patients with prostate cancer (PC). We analyzed differences in outcome between ART and SRT in patients with steep decline of PSA-levels after surgery to compare outcome.MethodsWe evaluated 253 patients treated with postoperative RT with a median age of 66 years (range 42–85 years) treated between 2004 and 2014. Patients with additive radiotherapy due to PSA persistence and patients in the SRT group, who did not achieve a postoperative PSA level <0.1 ng/mL were excluded. Hence, data of 179 patients was evaluated. We used propensity score matching to build homogenous groups. A Cox regression model was used to determine differences between treatment options. Median follow-up was 32.5 months (range 1.4–128.0 months).ResultsEarly SRT at PSA levels <0.3 ng/mL was associated with significant longer BCRFS than late SRT (HR: 0.32, 95%-CI: 0.14–0.75, p = 0.009). Multiple Cox regression showed pre-RT PSA level, tumor stage, and Gleason score as predictive factors for biochemical relapse. In the overall group, patients treated with either ART or early SRT showed no significant difference in BCRFS (HR: 0.17, 95%-CI: 0.02–1.44, p = 0.1). In patients with locally advanced PC (pT3/4) BCRFS was similar in both groups as well (HR: 0.21, 95%-CI:0.02–1.79, p = 0.15).ConclusionFor patients with PSA-triggered follow-up, close observation is essential and early initiation of local treatment at low PSA levels (<0.3 ng/mL) is beneficial. Our data suggest, that SRT administered at early PSA rise might be equieffective to postoperative ART in patients with locally advanced PC. However, the individual treatment decision must be based on any adverse risk factors and the patients’ postoperative clinical condition.Study registrationThe present work is approved by the Ethics Commission of the Technical University of Munich (TUM) and is registered with the project number 320/14.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Shakespeare et al [11] estimated that 17% of men regretted their decision of adding RT after their surgery, mainly due to side-effects. The most commonly reported side-effects are those of the urinary tract and the anorectal tract, but also decreased sexual function [12]. Some sideeffects may present many years after RT.…”

Section: Introductionmentioning

confidence: 99%

Risk of severe late toxicity after radiotherapy following radical prostatectomy – a nationwide study

et al. 2022

View full text Add to dashboard Cite

Objective To estimate the long‐term risks of severe late toxicities for radiation therapy (RT) following radical prostatectomy (RP) in an unselected nationwide cohort, as severe side‐effects are rare but may occur years later. Patients and Methods The study population comprised all men undergoing RP between 1997 and 2016 in the Prostate Cancer database Sweden (PCBaSe) (n = 40 962). By (1:2) matching, two cohorts were created: 2789 men exposed to postoperative RT and 5578 unexposed men with comparable age, comorbidities, and year of surgery. Cumulative incidences and rate ratios were calculated for the following outcomes: symptoms and interventions of the urinary or intestinal tract demanding inpatient care, secondary malignancies, and non‐prostate cancer mortality. Results The largest differences were seen for late toxicities affecting the urinary tract. The 10‐year cumulative incidences among those exposed to postoperative RT vs the RP‐only group were: 17.8% vs 10.5% for procedures of the urinary tract (difference 7.3%, 95% confidence interval [CI] 4.4 to 10.3; relative risk [RR] 1.74, 95% CI 1.47 to 2.05); 6.0% vs 1.2% for haematuria (difference 4.8%, 95% CI 3.1 to 6.5; RR 6.50, 95% CI 4.31 to 10.10); and 2.4% vs 1.1% for bladder cancer (difference 1.4%, 95% CI 0.4 to 2.3; RR 2.71, 95% CI 1.72 to 4.33). The groups were similar regarding intestinal toxicity, other secondary malignancies, and non‐prostate cancer mortality. Adjustments for preoperative tumour risk factors did not importantly affect the rate ratios. Conclusion Severe late toxicity after postoperative RT following RP predominately affects the bladder and can appear many years after RT.

show abstract

“…Nevertheless, even if a very early initiation of SRT may independently reduce the risk of subsequent disease progression [2,3,8,10], some reports indicate that delaying post-prostatectomy radiotherapy (even in the case of ART) could exert a protective effect on long term UI recovery after RP [11][12][13]. Although this issue is still controversial [14][15][16][17], clinicians may increasingly have to deal with the dilemma of postponing SRT despite a rising PSA until satisfactory urinary continence is achieved, or proceed to immediate SRT at the first evidence of detectable PSA values regardless of an incompletely recovered pre-radiotherapy UI. In addition, it has been generally well ascertained that rigorous studies dealing with "patientreported" UI, which detail patient's quality of life better than "physician-reported" UI, are lacking [18].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Patient-Reported Incontinence at Adjuvant/Salvage Radiotherapy after Prostatectomy: Impact of Time between Surgery and Radiotherapy

Muñoz

Sanguineti

Bresolin

et al. 2021

Cancers

View full text Add to dashboard Cite

Background: Baseline urinary incontinence (UI) strongly modulates UI recovery after adjuvant/salvage radiotherapy (ART/SRT), inducing clinicians to postpone it “as much as possible”, maximizing UI recovery but possibly reducing efficacy. This series aims to analyze the trend of UI recovery and its predictors at radiotherapy start. Methods: A population of 408 patients treated with ART/SRT enrolled in a cohort study (ClinicalTrials.gov #NCT02803086) aimed at developing predictive models of radiation-induced toxicities. Self-reported UI and personality traits, evaluated by means of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and Eysenck Personality Questionnaire - Revised (EPQ-R) questionnaires, were assessed at ART/SRT start. Several endpoints based on baseline ICIQ-SF were investigated: frequency and amount of urine loss (ICIQ3 and ICIQ4, respectively), “objective” UI (ICIQ3 + 4), “subjective” UI (ICIQ5), and “TOTAL” UI (ICIQ3 +4 + 5). The relationship between each endpoint and time from prostatectomy to radiotherapy (TTRT) was investigated. The association between clinical and personality variables and each endpoint was tested by uni- and multivariable logistic regression. Results: TTRT was the strongest predictor for all endpoints (p-values ≤ 0.001); all scores improved between 4 and 8 months after prostatectomy, without any additional long-term recovery. Neuroticism independently predicted subjective UI, TOTAL UI, and daily frequency. Conclusions: Early UI recovery mostly depends on TTRT with no further improvement after 8 months from prostatectomy. Higher levels of neuroticism may overestimate UI.

show abstract

Early and late toxicity profiles of patients receiving immediate postoperative radiotherapy versus salvage radiotherapy for prostate cancer after prostatectomy

Cited by 5 publications

References 35 publications

Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy

Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy

Risk of severe late toxicity after radiotherapy following radical prostatectomy – a nationwide study

Predictors of Patient-Reported Incontinence at Adjuvant/Salvage Radiotherapy after Prostatectomy: Impact of Time between Surgery and Radiotherapy

Contact Info

Product

Resources

About