TY - JOUR
T1 - Salvage radiation therapy for biochemical failure following radical prostatectomy
AU - Spieler, Benjamin
AU - Goldstein, Jeffrey
AU - Lawrence, Yaacov R.
AU - Saad, Akram
AU - Berger, Raanan
AU - Ramon, Jacob
AU - Dotan, Zohar
AU - Laufer, Menachem
AU - Weiss, Ilana
AU - Tzvang, Lev
AU - Poortmans, Philip
AU - Symon, Zvi
N1 - Publisher Copyright:
© 2017, Israel Medical Association. All rights reserved.
PY - 2017/1
Y1 - 2017/1
N2 - Background: Radiotherapy to the prostate bed is used to eradicate residual microscopic disease following radical prostatectomy for prostate cancer. Recommendations are based on historical series. Objectives: To determine outcomes and toxicity of contemporary salvage radiation therapy (SRT) to the prostate bed. Methods: We reviewed a prospective ethics committee approved-database of 229 patients referred for SRT. Median preradiation prostate-specific antigen (PSA) was 0.5 ng/ml and median follow-up was 50.4 months (range 13.7–128). Treatment was planned and delivered using modern three-dimensional radiation techniques. Mean bioequivalent dose was 71 Gy (range 64–83 Gy). Progression was defined as two consecutive increases in PSA level > 0.2 ng/ml, metastases on follow-up imaging, commencement of anti-androgen treatment for any reason, or death from prostate cancer. Kaplan-Meier survival estimates and multivariate analysis were performed using STATA. Results: Five year progression-free survival was 68% (95%CI 59.8–74.8%), and stratified by PSA the rates were 87%, 70% and 47% for PSA < 0.3, 0.3–0.7 and > 0.7 ng/ml (P < 0.001). Metastasis-free survival was 92.5%, prostate cancer-specific survival 96.4%, and overall survival 94.9%. Low pre-radiation PSA value was the most important predictor of progression-free survival (HR 2.76, P < 0.001). Daily image guidance was associated with reduced risk of gastrointestinal and genitourinary toxicity (P < 0.005). Conclusions: Contemporary SRT is associated with favorable outcomes. Early initiation of SRT at PSA < 0.3 ng/ml improves progression-free survival. Daily image guidance with online correction is associated with a decreased incidence of late toxicity.
AB - Background: Radiotherapy to the prostate bed is used to eradicate residual microscopic disease following radical prostatectomy for prostate cancer. Recommendations are based on historical series. Objectives: To determine outcomes and toxicity of contemporary salvage radiation therapy (SRT) to the prostate bed. Methods: We reviewed a prospective ethics committee approved-database of 229 patients referred for SRT. Median preradiation prostate-specific antigen (PSA) was 0.5 ng/ml and median follow-up was 50.4 months (range 13.7–128). Treatment was planned and delivered using modern three-dimensional radiation techniques. Mean bioequivalent dose was 71 Gy (range 64–83 Gy). Progression was defined as two consecutive increases in PSA level > 0.2 ng/ml, metastases on follow-up imaging, commencement of anti-androgen treatment for any reason, or death from prostate cancer. Kaplan-Meier survival estimates and multivariate analysis were performed using STATA. Results: Five year progression-free survival was 68% (95%CI 59.8–74.8%), and stratified by PSA the rates were 87%, 70% and 47% for PSA < 0.3, 0.3–0.7 and > 0.7 ng/ml (P < 0.001). Metastasis-free survival was 92.5%, prostate cancer-specific survival 96.4%, and overall survival 94.9%. Low pre-radiation PSA value was the most important predictor of progression-free survival (HR 2.76, P < 0.001). Daily image guidance was associated with reduced risk of gastrointestinal and genitourinary toxicity (P < 0.005). Conclusions: Contemporary SRT is associated with favorable outcomes. Early initiation of SRT at PSA < 0.3 ng/ml improves progression-free survival. Daily image guidance with online correction is associated with a decreased incidence of late toxicity.
KW - Image-guided radiation therapy (IGRT)
KW - Prostate fossa
KW - Prostate-specific antigen (PSA)
KW - Salvage radiation therapy (SRT)
UR - http://www.scopus.com/inward/record.url?scp=85009471418&partnerID=8YFLogxK
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C2 - 28457109
AN - SCOPUS:85009471418
SN - 1565-1088
VL - 19
SP - 19
EP - 24
JO - Israel Medical Association Journal
JF - Israel Medical Association Journal
IS - 1
ER -