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Title: Adjuvant radiotherapy leads to superior biochemical recurrence free survival compared to early salvage radiotherapy in patients with locally advanced prostate cancer: results of a matched-controlled multi-institutional analysis
Authors: Briganti, A
Budiharto, T
Joniau, Steven
Capitanio, U
Cozzarini, C
Haustermans, Karin
Tombal, B
Di Muzio, N
Rigatti, P
Van Poppel, Hendrik #
Issue Date: Mar-2011
Publisher: Elsevier Science
Host Document: European Urology Supplements vol:10 issue:2 pages:93-94
Conference: Annual Congress of the European Association of Urology edition:26 location:Vienna, Austria date:18-22 March 2011
Article number: 228
Abstract: Introduction & Objectives: Previous prospective randomized trials have shown a significant benefit of adjuvant RT (aRT) in presence of positive surgical margins or locally advanced prostate cancer (PCa). It is currently unknown whether similar results can be achieved by administering early salvage RT (eSRT). This analysis aimed at comparing the effect of aRT vs eSRT on biochemical recurrence (BCR)
free survival in a large European multi-institutional cohort of men undergoing radical prostatectomy (RP), pelvic lymph node dissection and subsequent aRT or eSRT.
Materials & Methods: Within a study population of 515 patients treated with RP and either aRT or eSRT at three tertiary care centres, 420 pT2-4 R0-R1 pN0 patients (81.5%) who received either immediate aRT with undetectable PSA after surgery (n=313, 74.5%) or eSRT (defined as RT administered with a PSA value <0.5 ng/ml; n=107, 25.5%) were identified. We explored the effect of aRT vs eSRT
on BCR-free survival rates by relying on a retrospective matched case-control analysis. Exact matches (ratio 1:2) were made for pT stage (pT2 vs pT3 vs pT4), RP-Gleason sum (6 vs 7-10) and surgical margin (SM) status (SM+ vs SM-). The same analyses were repeated using a PSA cut-off <0.3 ng/ml to define eSRT (n=79) as well as in those patients who received higher RT doses (≥66 Gy). Kaplan-Meier and life table analyses addressed BCR free survival rates in the aRT and eSRT groups.
Results: Overall, mean follow-up was 78.5 months (median 76.7; range: 4.8-188 months). In the overall patient population (n=515), 2, 5 and 8-years BCR free survival rates were 95.4, 84.7 and 78.1%, 88, 65.4 and 44.6% in patients treated with aRT and sRT, respectively (p<0.001). Within 420 RP patients, 143 out of 313 (45.7%) patients treated with aRT were matched with 89 out of 107
(83.2%) patients who received sRT with a PSA value <0.5 ng/ml. After matching, no statistically significant difference was recorded between eSRT and aRT cases
in terms of clinical and pathological characteristics (all p≥0.06). The 2, 5 and 8-year BCR free survival rates were 95,82.3 and 72.8% in aRT vs 85.4,65.5 and 45.9% in eSRT patients (aRT vs eSRT, HR 0.6; p=0.038). Similar results were obtained when post-RP PSA cut-off to define eSRT was set at 0.3 ng/ml (2, 5 and 8-year BCR free survival rates were 91.7,78.4 and 70.7% vs 81.5,63.9 and 44.2% in aRT and eSRT patients, respectively, HR 0.37; p<0.001). Adjuvant RT was also associated with higher BCR free survival rates when the analyses were restricted to those patients receiving higher RT dose (≥66 Gy; p≤0.027)
Conclusions: This matched case-controlled study demonstrated that eSRT has a detrimental effect on BCR free survival as compared to aRT. Prospective, randomized studies are awaited to confirm these preliminary results.
ISSN: 1569-9056
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Laboratory of Experimental Radiotherapy
Urology Section (-)
# (joint) last author

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