Conformal Postoperative Radiotherapy in Patients With Positive Resection Margins and/or pT3-4 Prostate Adenocarcinoma

Journal Article · Thu Nov 01 04:00:00 EDT 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2012.04.002· OSTI ID:22149574

Bellavita, Rita ^[1]; Massetti, Michela ^[1]; Abraha, Iosief ^[2]; Lupattelli, Marco ^[1]; Mearini, Luigi ^[3]; Falcinelli, Lorenzo; Farneti, Alessia; Palumbo, Isabella ^[1]; Porena, Massimo ^[3]; Aristei, Cynthia ^[1]

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1. Institute of Radiation Oncology, General Hospital and Perugia University, Perugia (Italy)
2. Regional Health Authority of Umbria, General Hospital and Perugia University, Perugia (Italy)
3. Urology Department, General Hospital and Perugia University, Perugia (Italy)

Purpose: To evaluate outcome and toxicity of high-dose conformal radiotherapy (RT) after radical prostatectomy. Methods and Materials: Between August 1998 and December 2007, 182 consecutive patients with positive resection margins and/or pT3-4, node-negative prostate adenocarcinoma underwent postoperative conformal RT. The prescribed median dose to the prostate/seminal vesicle bed was 66.6 Gy (range 50-70). Hormone therapy (a luteinizing hormone-releasing hormone analogue and/or antiandrogen) was administered to 110/182 (60.5%) patients with high-risk features. Biochemical relapse was defined as an increase of more than 0.2 ng/mL over the lowest postoperative prostate-specific antigen (PSA) value measured on 3 occasions, each at least 2 weeks apart. Results: Median follow-up was 55.6 months (range 7.6-141.9 months). The 3- and 5-year probability of biochemical relapse-free survival were 87% and 81%, respectively. In univariate analysis, more advanced T stages, preoperative PSA values {>=}10 ng/mL, and RT doses <70 Gy were significant factors for biochemical relapse. Pre-RT PSA values >0.2 ng/mL were significant for distant metastases. In multivariate analysis, risk factors for biochemical relapse were higher preoperative and pre-RT PSA values, hormone therapy for under 402 days and RT doses of <70 Gy. Higher pre-RT PSA values were the only independent predictor of distant metastases. Acute genitourinary (GU) and gastrointestinal (GI) toxicities occurred in 72 (39.6%) and 91 (50%) patients, respectively. There were 2 cases of Grade III GI toxicity but no cases of Grade IV. Late GU and GI toxicities occurred in 28 (15.4%) and 14 (7.7%) patients, respectively: 11 cases of Grade III toxicity: 1 GI (anal stenosis) and 10 GU, all urethral strictures requiring endoscopic urethrotomy. Conclusions: Postoperative high-dose conformal RT in patients with high-risk features was associated with a low risk of biochemical relapse as well as minimal morbidity.

• OSTI ID: 22149574
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 84; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANTIGENS
CARCINOMAS
DISEASE INCIDENCE
GY RANGE 10-100
HEALTH HAZARDS
LUTEINIZING HORMONE
METASTASES
MULTIVARIATE ANALYSIS
PATIENTS
PROBABILITY
PROSTATE
RADIATION DOSES
RADIOTHERAPY
TOXICITY