Long-Term Outcomes After High-Dose Postprostatectomy Salvage Radiation Treatment

Goenka, Anuj; Magsanoc, Juan Martin; Pei, Xin; Schechter, Michael S.; Cox, Brett; Scardino, Peter T.; Eastham, James A.; Zeléfsky, Michael J.

doi:10.1016/j.ijrobp.2011.10.077

Cited by 90 publications

(88 citation statements)

References 20 publications

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“…Retrospective studies have shown that salvage EBRT in patients who experience recurrence of disease after undergoing RP offers a prolonged BFR of survival. Most of the studies, however, have a postirradiation follow-up of less than 5 years [5,9,10]. Furthermore, the salvage EBRT doses in the majority of these studies are now considered low doses of radiation (66 Gy) [4,5,17].…”

Section: Discussionmentioning

confidence: 99%

“…Biochemical failure after salvage EBRT was defined as detection of a postsalvage radiation PSA value greater than 0.2 ng/ml followed by a second PSA level higher than the first by any amount, by a continued increase in PSA level after treatment greater than the pretreatment PSA level, or by the initiation of ADT after salvage EBRT [9].…”

Section: Postirradiation Evaluationmentioning

confidence: 99%

“…Reports have demonstrated that salvage EBRT provides effective long-term BFR and freedom from metastasis in selected patients presenting with PSA recurrence after RP. Independent predictors of BFR after undergoing salvage EBRT include negative surgical margin status, vascular invasion, presalvage PSA level greater than 0.4 ng/ml, androgen deprivation therapy (ADT), Gleason score (GS) of 7 or higher, seminal vesicle invasion (SVI), pre-EBRT prostate-specific antigen doubling time (PSADT) shorter than 12 months, and presalvage EBRT PSA level [5,9,10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prostate-specific antigen doubling time subsequent to radical prostatectomy is a predictor of outcome following salvage external beam radiation therapy: A single-centre experience

Servoll

Sæter

Vlatkovic³

et al. 2014

Scandinavian Journal of Urology

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Objective. The aim of this study was to review the impact of salvage external beam radiotherapy (EBRT) of postprostatectomy patients with long-term follow-up on biochemical-free recurrence (BFR) and metastatic-free survival, and to describe pathological and clinical predictors of outcome. Materials and methods. In the period 1987-2010, 76 postprostatectomy patients with biochemical and clinical recurrence received salvage EBRT. Patients were treated with conformal EBRT and 68 (90%) received a dose of 70 Gy; eight patients (10%) received a dose of 60-64 Gy. No patients received adjuvant or neoadjuvant androgen deprivation therapy in conjunction with salvage EBRT. Results. The median follow-up time after salvage EBRT was 82 months (range 5-192 months). Seventeen patients (22%) developed biochemical recurrence subsequent to postprostatectomy salvage EBRT during the observation time, and the overall 50 and 75 month actuarial BFR rates after salvage EBRT were 84% and 79%, respectively. Seven patients (9%) developed metastatic disease and two patients died of prostate cancer. Independent predictors of biochemical recurrence were seminal vesicle invasion (SVI) in the prostatectomy specimen (p < 0.05) and prostate-specific antigen doubling time (PSADT) of 6 months or less (p = 0.041) before salvage EBRT. Conclusions. Salvage EBRT provides effective long-term BFR and metastatic-free survival in a selected group of patients with detectable, rising prostate-specific antigen values following radical prostatectomy. SVI and PSADT are prognostic variables for a non-durable response to salvage EBRT and thus predictors of high-risk prostate cancer in patients in whom neoadjuvant and adjuvant androgen deprivation therapy should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Postirradiation Evaluationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prostate-specific antigen doubling time subsequent to radical prostatectomy is a predictor of outcome following salvage external beam radiation therapy: A single-centre experience

Servoll

Sæter

Vlatkovic³

et al. 2014

Scandinavian Journal of Urology

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“…11 Nevertheless, the recent survey among US physicians revealed that 55% delivers doses of at least 70 Gy and 91% uses IMRT, although only 2 groups have published their 5-year results using such doses with this technique. 41,42 From these studies it can be concluded that high dose salvage EBRT is probably safe when IMRT is used with 1% and 3% grade 3 GI and GU toxicity, respectively. For patients with pre-treatment PSA <0,5 ng/ml, the 5-year PSA control is promising with >70% of patients having their disease controlled.…”

Section: Dose-escalation In the Salvage Setting For Pcmentioning

confidence: 98%

“…For patients with pre-treatment PSA <0,5 ng/ml, the 5-year PSA control is promising with >70% of patients having their disease controlled. 41,42 Currently, Swiss Group for Clinical Cancer Research (SAKK) is conducting a phase 3 trial (SAKK 09/10) that compares salvage radiotherapy with 64 Gy versus 70 Gy without hormonal treatment in patients without macroscopic biochemical recurrence after prostatectomy (ClinicalTrials.gov identifier: NCT01272050). This trial will help us further define the role of dose-escalation in the salvage setting.…”

Section: Dose-escalation In the Salvage Setting For Pcmentioning

confidence: 99%

Developments in External Beam Radiotherapy for Prostate Cancer

Lumen

Ost

Praet

et al. 2013

Urology

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Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy

Goldin¹,

Sheets²,

Meyer³

et al. 2013

JAMA Intern Med

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Importance: Comparative effectiveness research of prostate cancer therapies is needed because of the development and rapid clinical adoption of newer and costlier treatments without proven clinical benefit. Radiotherapy is indicated after prostatectomy in select patients who have adverse pathologic features and in those with recurrent disease.Objectives: To examine the patterns of use of intensitymodulated radiotherapy (IMRT), a newer, more expensive technology that may reduce radiation dose to adjacent organs compared with the older conformal radiotherapy (CRT) in the postprostatectomy setting, and to compare disease control and morbidity outcomes of these treatments.Design and Setting: Data from the Surveillance, Epidemiology, and End Results-Medicare-linked database were used to identify patients with a diagnosis of prostate cancer who had received radiotherapy within 3 years after prostatectomy.Participants: Patients who received IMRT or CRT. Main Outcomes and Measures:The outcomes of 457 IMRT and 557 CRT patients who received radiotherapy between 2002 and 2007 were compared using their claims through 2009. We used propensity score methods to balance baseline characteristics and estimate adjusted incidence rate ratios (RRs) and their 95% CIs for measured outcomes.Results: Use of IMRT increased from zero in 2000 to 82.1% in 2009. Men who received IMRT vs CRT showed no significant difference in rates of long-term gastrointestinal morbidity (RR, 0.95; 95% CI, 0.66-1.37), urinary nonincontinent morbidity (0.93; 0.66-1.33), urinary incontinence (0.98; 0.71-1.35), or erectile dysfunction (0.85; 0.61-1.19). There was no significant difference in subsequent treatment for recurrent disease (RR,1.31; 95% CI, 0.90-1.92).Conclusions and Relevance: Postprostatectomy IMRT and CRT achieved similar morbidity and cancer control outcomes. The potential clinical benefit of IMRT in this setting is unclear. Given that IMRT is more expensive, its use for postprostatectomy radiotherapy may not be cost-effective compared with CRT, although formal analysis is needed.

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Long-Term Outcomes After High-Dose Postprostatectomy Salvage Radiation Treatment

Cited by 90 publications

References 20 publications

Prostate-specific antigen doubling time subsequent to radical prostatectomy is a predictor of outcome following salvage external beam radiation therapy: A single-centre experience

Prostate-specific antigen doubling time subsequent to radical prostatectomy is a predictor of outcome following salvage external beam radiation therapy: A single-centre experience

Developments in External Beam Radiotherapy for Prostate Cancer

Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy

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