Dose-escalated salvage radiotherapy after radical prostatectomy in high risk prostate cancer patients without hormone therapy: outcome, prognostic factors and late toxicity

Radiation Oncology

Frank Lohr²  Frederik Wenz²  Nadim Behnam²  Julia Kosakowski²  Christian Bolenz³  Grit Welzel²  Yasser Abo-Madyan¹  Mohamed Shelan² 

[1] Department of Radiation Oncology and Nuclear Medicine (NEMROCK), Faculty of Medicine, Cairo University, Cairo, Egypt;Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany;Department of Urology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

关键词: Dose escalation;    Salvage radiotherapy;    Radical prostatectomy;   

Others  :  829655
DOI  :  10.1186/1748-717X-8-276

 received in 2013-06-15, accepted in 2013-11-17,  发布年份 2013

【 摘 要 】

Purpose

Evaluation of dose escalated salvage radiotherapy (SRT) in patients after radical prostatectomy (RP) who had never received antihormonal therapy. To investigate prognostic factors of the outcome of SRT and to analyze which patient subsets benefit most from dose escalation.

Materials and methods

Between 2002 and 2008, 76 patients were treated in three different dose-groups: an earlier cohort treated with 66 Gy irrespective of pre-RT-characteristics and two later cohorts treated with 70 Gy or 75 Gy depending on pre-RT-characteristics. Biochemical-relapse-free-survival (bRFS), clinical-relapse-free-survival (cRFS) and late toxicity were evaluated.

Results

Four-year bRFS and cRFS were 62.5% and 85%. Gleason score <8, positive surgical resection margin (PSRM) and low PSA (≤0.5 ng/ml) before SRT resulted in higher bRFS. Analysis of the whole group showed no clear dose-outcome relationship. Patients with PSRM, however, had improved bRFS when escalating >66 Gy. While > 70 Gy did not improve the overall results, 4-year bRFS for patients with manifest local recurrence in the high-dose group was still comparable to those without manifest local recurrences. No grade 4 and minimal grade 3 gastrointestinal and urinary toxicity were observed.

Conclusions

Dose-escalated SRT achieves high biochemical control. The data strongly support the application of at least 70 Gy rather than 66 Gy. They do not prove positive effects of doses >70 Gy but do not disprove them as these doses were only applied to an unfavorable patients selection.

【 授权许可】

   
2013 Shelan et al.; licensee BioMed Central Ltd.

【 图 表 】

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