Radiat Oncol J.  2014 Sep;32(3):179-186. 10.3857/roj.2014.32.3.179.

Long-term tolerance and outcomes for dose escalation in early salvage post-prostatectomy radiation therapy

• Safdieh JJ
• Schwartz D
• Weiner J
• Weiss JP
• Rineer J
• Madeb I
• Rotman M
• Schreiber

• KMID: 2316733
• DOI: http://doi.org/10.3857/roj.2014.32.3.179

Abstract

PURPOSE
To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting.
MATERIALS AND METHODS
The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes.
RESULTS
The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%).
CONCLUSION
In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.

Keyword

Dose escalation; Prostate cancer; Radiation therapy; Salvage

MeSH Terms

Follow-Up Studies
Humans
Medical Records
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Radiotherapy
Prostate-Specific Antigen