The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

Tyldesley, Scott; Peacock, Michael; Morris, James; So, Alan; Quirt, Jill Quirt; Carter, Michael; Pickles, Tom

doi:10.5489/cuaj.11158

Cited by 21 publications

(7 citation statements)

References 39 publications

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“…One third of these patients are likely to show tumor recurrence after surgery. 19 , 20 An increasing risk of recurrence is observed in patients with high Gleason score and positive, margins and these patients benefit from a postsurgery RT. In fact, adjuvant RT has been demonstrated to both increase progression-free survival (PFS) in different randomized trials and, in one of these trials, also to increase OS.…”

Section: Discussionmentioning

confidence: 99%

Moderate hypofractionated radiotherapy after prostatectomy for cancer patients: toxicity and clinical outcome

Barra

Belgioia

Marcenaro

et al. 2018

CMAR

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BackgroundAfter radical prostatectomy (RP) radiotherapy (RT) plays a role, both as adjuvant or salvage treatment. If negative features are present such as extracapsular extension, seminal vesicle invasion, lymph invasion, and positive surgical margins, RT after RP reduces the risk of recurrence, although it is associated with an increased risk of acute and late toxicities. An intensified RT delivered in a shortened time could improve clinical outcome and be safely combined with hormonal therapy (HT). The aim of this study was to determine the acute and late toxicities associated with hypofractionated RT and to assess the impact of the addition of HT to RT in high-risk prostate cancer (PC) patients on overall response and toxicity.Materials and methodsSixty-four PC patients undergoing RP were included in this retrospective study. All patients were recommended to receive adjuvant or salvage RT. Prescription doses were 62.5 Gy in 25 fractions to prostate bed, 56.25 Gy in 25 fractions to seminal vesicles bed, and 50 Gy in 25 fractions to pelvis if indicated. HT was administered to patients with additional adverse pathologic features including Gleason score >7, prostate-specific antigen >20 ng/mL before surgery, or prostate-specific antigen with rapid doubling time after relapse or nodal involvement. After completion of RT, patients were observed after 4 weeks, and then followed-up every 3–6 months. Acute and late toxicities were assessed using Common Terminology Criteria for Adverse Events v4 and Radiation Therapy Oncology Group scale, respectively.ResultsFor acute toxicity, only grade 1 gastrointestinal and genitourinary toxicities were detected in 17% and 11% of patients, respectively. As regards late toxicity, only 5% of the patients developed grade 1 gastrointestinal adverse event; grade 1, grade 2, and grade 3 genitourinary toxicity was recorded in 5%, 3.3%, and 3.3% of patients, respectively. Two and 5 years overall survival were 98% and 96%, respectively. The curves stratified for treatment show a slight difference between patients receiving RT or RT+HT, but the differences did not reach statistical significance (p=0.133).ConclusionIn patients with PC undergoing RP, hypofractionated RT may contribute to achieve a high overall survival with an acceptable toxicity profile. Combination of RT and HT is also well tolerated and efficacious.

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Section: Discussionmentioning

confidence: 99%

Moderate hypofractionated radiotherapy after prostatectomy for cancer patients: toxicity and clinical outcome

Barra

Belgioia

Marcenaro

et al. 2018

CMAR

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“…13 Numerous patterns of care studies demonstrate that ongoing controversy surrounding adjuvant radiotherapy and persisting clinical uncertainty is reflected in historically low rates of utilisation of adjuvant radiation in this patient group. These studies consistently report only 10-20% of eligible patients receive treatment in Australia, [14][15][16][17] Canada 18,19 and the USA [20][21][22][23] , and rates did not increase following the publication of randomised controlled trial data. Further, a retrospective analysis of data from the US National Cancer Data Base indicates declining use of radiotherapy for adverse features after radical prostatectomy.…”

Section: Introductionmentioning

confidence: 91%

Changing attitudes towards management of men with locally advanced prostate cancer following radical prostatectomy: A follow‐up survey of Australia‐based urologists

et al. 2016

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Introduction: This study examined whether there has been change among Australia-based urologists' knowledge, attitudes and beliefs relating to guideline-recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy since a prior survey in 2012 and investigated associations between attitudes and treatment preferences. Methods: A nationwide survey of Australia-based urologist members of the Urological Society of Australia and New Zealand. Results: Ninety-six respondents completed the 2015 survey (30% response rate) compared with 157 (45% response rate) in 2012. There was no significant change in awareness of national clinical practice guidelines for the management of prostate cancer. When considering adjuvant against salvage radiotherapy, urologists were significantly less favourable towards adjuvant radiotherapy in 2015 than in 2012 for two of three hypothetical clinical case scenarios with a high 10-year risk of biochemical relapse according to Memorial Sloan Kettering Cancer Center nomograms (P < 0.001 for both cases). In 2015, urologists were less positive overall towards the recommendation for post-operative adjuvant radiotherapy for men with locally advanced prostate cancer than in 2012 (P < 0.001), reflecting a significant change across a number of attitudes and beliefs. Of note, urologists felt other urologists would more likely be critical if they routinely referred the target patient group for radiotherapy in 2015 compared with 2012 (P = 0.007). Conclusion: In 2015 Australia-based urologists were less favourable towards adjuvant radiotherapy over watchful waiting for men with high-risk pathologic features post-prostatectomy than in 2012. We could find no new published research that precipitated this change in attitude.

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“…[17][18][19][20][21][22] Sineshaw et al 23 looked at the National Cancer Data Base in the U.S. and found a significant drop in the utilization rate of postoperative RT in prostate cancer patients with adverse pathological factors between 2005 and 2011 from 9.1-7.3%. However, this study and the other cited publications do not report the referral rates to a radiation oncology department.…”

Section: Potential Factors Contributing To Slow Uptake Of Guideline Rmentioning

confidence: 99%

Assessing guideline impact on referral patterns of postprostatectomy patients to radiation oncologists

Taggar

Alghamdi

Tilly

et al. 2016

CUAJ

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Introduction: Adjuvant radiotherapy (aRT) can improve biochemical progression-free survival in patients with high-risk features (HRF) after radical prostatectomy (RP). Guidelines from Alberta and the Genitourinary Radiation Oncologists of Canada (GUROC) recommend that patients with HRF be referred to radiation oncologists (RO) based on the findings from three randomized, controlled trials (RCT). Our study examines the impact of these recommendations both pre- (2005) There was a marked drop in patients referred for salvage radiation therapy beyond six months and a rise in the number of patients who are never referred. Conclusions: Despite an increase in referral rates to RO post-RP from 2005-2012, more than 50% of those patients with HRF did not receive a referral. Initiatives aimed at improving multidisciplinary care and guideline adherence should be undertaken.

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The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

Abstract: Not all patients with adverse prostatectomy pathology were seen by a radiation oncologist post-prostatectomy, and very few received adjuvant radiotherapy despite almost half of them having risk factors for relapse.

Cited by 21 publications

References 39 publications

Moderate hypofractionated radiotherapy after prostatectomy for cancer patients: toxicity and clinical outcome

Moderate hypofractionated radiotherapy after prostatectomy for cancer patients: toxicity and clinical outcome

Changing attitudes towards management of men with locally advanced prostate cancer following radical prostatectomy: A follow‐up survey of Australia‐based urologists

Assessing guideline impact on referral patterns of postprostatectomy patients to radiation oncologists

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