Effect of higher radiation dose on biochemical control after radical prostatectomy for pT3N0 prostate cancer

Valicenti, Richard K.; Gomella, Leonard G.; Ismail, Mohammed; Mulholland, S. Grant; Petersen, Robert O.; Corn, Benjamin W.

doi:10.1016/s0360-3016(98)00270-3

Cited by 89 publications

(40 citation statements)

References 21 publications

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“…In our experience, the 5-year biochemical FFF rate was 56% with doses of Ն 64 Gy as compared with 36% with lesser doses (P ‫)81.0ס‬ [21]. Similar results were published by Valicenti et al, who achieved a 3-year biochemical FFF rate of 79% with Ն 64.8 Gy as compared with 33% with lesser doses (P ‫ס‬ 0.02) [16].…”

Section: Salvage Rt Following a Rise In Serum Psa Levelssupporting

confidence: 87%

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Radiation therapy (RT) after prostatectomy: The case for salvage therapy as opposed to adjuvant therapy

Schild

2001

Intl Journal of Cancer

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Section: Salvage Rt Following a Rise In Serum Psa Levelssupporting

confidence: 87%

“…Although we were unable to define a relationship between the RT dose and outcome, Valicente et al reported a dose-response for patients treated with immediate adjuvant RT. Patients who received Ն 61.5 Gy had a 3-year biochemical FFF rate of 91% as compared with 57% with lesser doses (P ‫ס‬ 0.01) [16].…”

Section: Adjuvant Rt In the Psa Eramentioning

confidence: 96%

Radiation therapy (RT) after prostatectomy: The case for salvage therapy as opposed to adjuvant therapy

Schild

2001

Intl Journal of Cancer

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“…In most of these series with adjuvant RT, 5-year local control rates were 95-100%, compared to 79-83% without adjuvant treatment [9,[17][18][19][20][21][22]. Additionally, significantly improved biochemical control rates (with undetectable PSA following RT -i.e., below values of 0.2 or 0.3 ng/ml) were shown in about 5-6 major retrospective series (table 2) [18,[20][21][22][23][24]. In a recently published series, Valicenti et al [25] demonstrated data of a matched-pair analysis of 72 patients with or without adjuvant RT after RP.…”

Section: Adjuvant Rt For Pt3 Tumors With or Without Positive Marginsmentioning

confidence: 96%

“…infiltration of seminal vesicles, have a high rate of distant micrometastases and possibly do not benefit from local RT [17,26]. Valicenti et al [24] have shown that in case of RT for increasing PSA after RP, higher doses are necessary to achieve an undetectable PSA value, most probably because of a larger tumor burden. For 52 patients with undetectable pre-RT PSA levels the 3-year NED (no evidence of disease) rate was 91% for patients irradiated to 61.5 Gy or more and 57% for those irradiated to lower doses (p < 0.05).…”

Section: Adjuvant Rt For Pt3 Tumors With or Without Positive Marginsmentioning

confidence: 99%

Adjuvant and Salvage Radiotherapy after Radical Prostatectomy

et al. 2002

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Background: Following radical prostatectomy, between 15 and 60% of all patients with pT3 prostate cancer experience persistence or increasing levels of prostate-specific antigen (PSA) as a sign of tumor persistence or progression within 5 years. Retrospective studies have shown a rate of 35–55% of positive biopsies from the vesicourethral anastomosis in this situation. Best treatment for these disease conditions is under debate, current strategies include adjuvant radiotherapy (RT), ‘wait-and-see‘ and salvage RT or hormone therapy for increasing PSA. Results: A number of retrospective studies have shown an increased rate of local control and ‘freedom from treatment failure‘ following adjuvant RT with doses in the range of 50–60 Gy. However, no survival benefit could be demonstrated by now. Results of three major phase III studies are pending. In case of persisting or increasing PSA levels following radical prostatectomy, 30–70% of these patients will reach an undetectable PSA level after conformal RT with total doses of 60–70 Gy, which will stay undetectable or at least stable within the next 2–5 years in about 50% and therefore offering a chance of cure. When starting RT, PSA should be as low as possible (<2 ng/ml). With higher PSA levels the chance of achieving an undetectable PSA again decreases below 35%. High Gleason scores of 8–10, seminal vesicle involvement and a short PSA doubling time are adverse prognostic factors. Severe late side effects of conformal RT are infrequent (<3%). In contrast, hormonal treatment is of palliative nature in the long run, with a median time to development of metastases of 4–7 years, and can be offered to patients with progressive disease after RT. Conclusions: Adjuvant RT following radical prostatectomy for pT3 prostate cancer offers higher local control rates and an increase in ‘freedom from treatment failure‘, but no prolongation of survival has yet been shown. In the situation of increasing PSA levels after radical prostatectomy, salvage RT seems to offer a chance of cure in selected patients, although it is difficult to draw firm conclusions because of generally too short follow-up times.

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“…With treatment fields limited to prostatic bed and doses of 60-62 Gy, rates of serious side effects are lower than 5%, 2,12 and seems to remain within this range also with the dose escalation to 70 Gy. 13,14 However, low grade toxicity seems to be quite common. In the survey of 75 patients, Pearce reported the incidence of any toxicity registered at any point during the median follow up of 45 months, after the irradiation of 60-66 Gy to prostatic bed, to be 51% for intestinal and 78% for urinary tract.…”

Section: Discussionmentioning

confidence: 99%

Increased late urinary toxicity with whole pelvic radiotherapy after prostatectomy

Kragelj¹

2009

Radiology and Oncology

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Effect of higher radiation dose on biochemical control after radical prostatectomy for pT3N0 prostate cancer

Cited by 89 publications

References 21 publications

Radiation therapy (RT) after prostatectomy: The case for salvage therapy as opposed to adjuvant therapy

Radiation therapy (RT) after prostatectomy: The case for salvage therapy as opposed to adjuvant therapy

Adjuvant and Salvage Radiotherapy after Radical Prostatectomy

Increased late urinary toxicity with whole pelvic radiotherapy after prostatectomy

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