Long-term tolerance and outcomes for dose escalation in early salvage post-prostatectomy radiation therapy - Abstract

PURPOSE: To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting.

MATERIALS AND METHODS: The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes.

RESULTS: The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%).

CONCLUSION: In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.

Written by:
Safdieh JJ, Schwartz D, Weiner J, Weiss JP, Rineer J, Madeb I, Rotman M, Schreiber D.   Are you the author?
Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA; University of Florida Health Cancer Center, Orlando, FL, USA.

Reference: Radiat Oncol J. 2014 Sep;32(3):179-86.
doi: 10.3857/roj.2014.32.3.179

PubMed Abstract
PMID: 25324990

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