Korean J Urol.  2015 Nov;56(11):735-741. 10.4111/kju.2015.56.11.735.

Long-term oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer: Systemic review and meta-analysis of 5-year and 10-year follow-up data

Affiliations
  • 1Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. hongkooha@pusan.ac.kr
  • 2Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Abstract

PURPOSE
To evaluate the oncologic outcomes between adjuvant radiotherapy (ART) and salvage radiotherapy (SRT) in patients with locally advanced prostate cancer or with adverse pathologic factors including positive surgical margin and high Gleason score.
MATERIALS AND METHODS
We searched the literature published from January 2000 until December 2014 at MEDLINE, PubMed, Web of Science, Embase, ProQuest, and Cochrane Library. To be specific, included were studies comparing ART and SRT settings if they followed up oncologic outcomes more than 5 years.
RESULTS
Overall, 3 retrospective, nonrandomized, observational studies, 1 matched control analysis, and 3 prospective randomized controlled studies met our inclusion criteria including a total of 2,380 patients (1,192 ART vs. 1,188 SRT). Higher favorable results were found in ART than in SRT was seen in the 5-year and 10-year biochemical recurrence (BCR)-free survival (risk ratio [RR], 0.61 and 0.70; 95% confidence interval [CI], 0.54-0.69 and 0.63-0.76). ART had a significantly higher 5-year progression-free survival rate than that in SRT (RR, 0.64; 95% CI, 0.51-0.80), but this was not the same for the 10-year progression-free survival rate (RR, 0.88; 95% CI, 0.72-1.08). There was no significant difference for the 5-year and 10-year overall survival rates between ART and SRT (RR, 0.80 and 0.94; 95% CI, 0.59-1.07 and 0.80-1.11).
CONCLUSIONS
ART showed favorable results in BCR-free survival during the 5-year follow-up period. However, the 10-year progression-free survival and overall survival did not show any difference between ART and SRT.

Keyword

Prostatic neoplasms; Adjuvant radiotherapy; Salvage therapy; Treatment outcome

MeSH Terms

Follow-Up Studies
Humans
Male
Prostatic Neoplasms/*radiotherapy/surgery
Publication Bias
Radiotherapy, Adjuvant
Salvage Therapy/*methods
Sensitivity and Specificity
Treatment Outcome

Figure

  • Fig. 1 Flow diagram.

  • Fig. 2 Publication bias analysis of included studies.

  • Fig. 3 Forest and funnel plots of each parameter at 5-year follow-up. (A) 5-year biochemical recurrence free survival. (B) 5-year progression free survival. (C) 5-year overall survival. M-H, Mantel-Haenszel test; CI, confidence interval; df, degree of freedom; SWOG, Southwest Oncology Group; ARO, Arbeitsge-meinschaft Radiologische Onkologie; EORTC, European Organization for the Research and Treatment of Cancer; RR, risk ratio; RTx, radiotherapy.

  • Fig. 4 Forest and funnel plots of each parameter at 10-year follow up. (A) 10-year biochemical recurrence free survival. (B) 10-year progression free survival. (C) 10-year overall survival. M-H, Mantel-Haenszel test; CI, confidence interval; df, degree of freedom; SWOG, Southwest Oncology Group; ARO, Arbeitsgemeinschaft Radiologische Onkologie; EORTC, European Organization for the Research and Treatment of Cancer; RR, risk ratio; RTx, radiotherapy.


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