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Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer

Abstract

Purpose: To assess the ability of adjuvant irradiation to prevent PSA failure in cases of pT3N0 disease, and of salvage irradiation to durably suppress a rising PSA following radical prostatectomy. Methods and Materials: 62 patients treated by post-operative radiation therapy (60-64Gy in 1.8Gy fractions to the tumor bed) between 1988 and 1993 were evaluated. All had complete pre- and post-radiation PSA data. Median follow up was 3.2 years from time of surgery and 2.2 years from irradiation. 20 patients had Gleason grade 3 disease (moderately differentiated) and 41 Gleason 4-5 (poorly differentiated). 46 had positive inked surgical margins, 18 involved seminal vesicles and 5 had palpable recurrent disease. None had known nodal or metastatic disease. 32 patients underwent adjuvant treatment (undetectable PSA at time of irradiation) and 30 salvage (detectable PSA at time of irradiation). Kaplan-Meier life table analysis was employed. The endpoint studied was freedom from biochemical failure. This was defined as a rise in the PSA of greater than 10% (intra laboratory error <8%) or a previously undetectable PSA becoming detectable. Results: The overall actuarial freedom from biochemical failure at 4 years from radiotherapy was 59%. A significant difference was seen between those receiving adjuvant and those receiving  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; FRACTIONATED IRRADIATION; NEOPLASMS; PROSTATE; RADIOTHERAPY; SURGERY
OSTI ID:
20391351
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R1762059398
Submitting Site:
INIS
Size:
page(s) 144
Announcement Date:
Nov 20, 2003

Citation Formats

Morris, M M, Dallow, K C, Zietman, A L, Althausen, A F, Heney, N M, McGovern, F J, and Shipley, W U. Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer. United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97672-N.
Morris, M M, Dallow, K C, Zietman, A L, Althausen, A F, Heney, N M, McGovern, F J, & Shipley, W U. Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer. United States. doi:10.1016/0360-3016(95)97672-N.
Morris, M M, Dallow, K C, Zietman, A L, Althausen, A F, Heney, N M, McGovern, F J, and Shipley, W U. 1995. "Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer." United States. doi:10.1016/0360-3016(95)97672-N. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97672-N.
@misc{etde_20391351,
title = {Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer}
author = {Morris, M M, Dallow, K C, Zietman, A L, Althausen, A F, Heney, N M, McGovern, F J, and Shipley, W U}
abstractNote = {Purpose: To assess the ability of adjuvant irradiation to prevent PSA failure in cases of pT3N0 disease, and of salvage irradiation to durably suppress a rising PSA following radical prostatectomy. Methods and Materials: 62 patients treated by post-operative radiation therapy (60-64Gy in 1.8Gy fractions to the tumor bed) between 1988 and 1993 were evaluated. All had complete pre- and post-radiation PSA data. Median follow up was 3.2 years from time of surgery and 2.2 years from irradiation. 20 patients had Gleason grade 3 disease (moderately differentiated) and 41 Gleason 4-5 (poorly differentiated). 46 had positive inked surgical margins, 18 involved seminal vesicles and 5 had palpable recurrent disease. None had known nodal or metastatic disease. 32 patients underwent adjuvant treatment (undetectable PSA at time of irradiation) and 30 salvage (detectable PSA at time of irradiation). Kaplan-Meier life table analysis was employed. The endpoint studied was freedom from biochemical failure. This was defined as a rise in the PSA of greater than 10% (intra laboratory error <8%) or a previously undetectable PSA becoming detectable. Results: The overall actuarial freedom from biochemical failure at 4 years from radiotherapy was 59%. A significant difference was seen between those receiving adjuvant and those receiving salvage irradiation (71% vs 51%, p=0.03). Amongst those in the salvage group neither the PSA prior to surgery, the PSA at the time of irradiation, the seminal vesicle status, nor the Gleason score (3 vs 4-5) correlated significantly with outcome. The time interval between surgery and irradiation was, however, significant. Those being treated within 6 months fared better than those treated later (60% vs 36%, p=0.04). Further, those treated early were more likely to achieve an undetectable nadir PSA level (94% vs 71%). Conclusion: The addition of adjuvant irradiation appears to improve the 4 year biochemical disease-free survival of patients with poor prognosis pT3N0 disease (positive surgical margins, involved seminal vesicles, palpably recurrent disease) compared with reports in the literature. Tumor bed irradiation renders approximately half the treated patients free from biochemical relapse at 4 years. Whether irradiation is truly more effective if delivered early or whether it is simply that late failures are more frequently metastatic remains uncertain.}
doi = {10.1016/0360-3016(95)97672-N}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}