BACKGROUND: Approximately 25% of patients treated with adjuvant radiotherapy (RT) will develop a biochemical failure within 5 yr after RT when doses of 60-64 Gray (Gy) are used. OBJECTIVE: To report on the safety and biochemical outcome of adjuvant intensity-modulated RT (IMRT) with doses >70 Gy. DESIGN, SETTING, AND PARTICIPANTS: Between 1999 and 2008, 104 patients underwent radical prostatectomy (RP) followed by adjuvant IMRT with or without androgen deprivation (AD) with a median follow-up of 36 mo. Indications for adjuvant IMRT were capsule perforation, seminal vesicle invasion (SVI) and/or positive surgical margins at prostatectomy specimen. All patients were irradiated at a single tertiary academic centre. AD was initiated on the basis of SVI, a preprostatectomy prostate-specific antigen level >20 ng/ml, Gleason score > or = 4+3 (n=36), or personal preference of the referring urologist (n=32). INTERVENTION: A median dose of 74 Gy was prescribed to the planning target volume using IMRT in all patients. AD consisted out of a luteinising hormone-releasing hormone analogue for 6 mo. MEASUREMENTS: We report on acute and late toxicity, biochemical relapse-free survival (bRFS), and clinical progression. The Kaplan-Meier method was used to estimate bRFS. Univariate analysis was used to examine the influence of patient- and treatment-related factors on bRFS. RESULTS AND LIMITATIONS: With respect to acute toxicity, no patients developed grade 3 gastrointestinal (GI) toxicity, and eight patients developed grade 3 genitourinary (GU) toxicity (8%). With respect to late toxicity, no patients developed grade 3 GI toxicity, and four patients (4%) developed grade 3 GU toxicity. A urethral stricture was observed in six patients (6%). The 3- and 5-yr actuarial bRFS was 93%. On univariate analysis, bRFS rates were worse when SVI (p<0.02), Gleason score > or = 4+3 (p<0.02), or negative surgical margins (p<0.02) were present. AD did not influence bRFS. Six patients had a clinical relapse. CONCLUSIONS: Adjuvant high-dose IMRT after prostatectomy is safe and bRFS is excellent.
BACKGROUND: Approximately 25% of patients treated with adjuvant radiotherapy (RT) will develop a biochemical failure within 5 yr after RT when doses of 60-64 Gray (Gy) are used. OBJECTIVE: To report on the safety and biochemical outcome of adjuvant intensity-modulated RT (IMRT) with doses >70 Gy. DESIGN, SETTING, AND PARTICIPANTS: Between 1999 and 2008, 104 patients underwent radical prostatectomy (RP) followed by adjuvant IMRT with or without androgen deprivation (AD) with a median follow-up of 36 mo. Indications for adjuvant IMRT were capsule perforation, seminal vesicle invasion (SVI) and/or positive surgical margins at prostatectomy specimen. All patients were irradiated at a single tertiary academic centre. AD was initiated on the basis of SVI, a preprostatectomy prostate-specific antigen level >20 ng/ml, Gleason score > or = 4+3 (n=36), or personal preference of the referring urologist (n=32). INTERVENTION: A median dose of 74 Gy was prescribed to the planning target volume using IMRT in all patients. AD consisted out of a luteinising hormone-releasing hormone analogue for 6 mo. MEASUREMENTS: We report on acute and late toxicity, biochemical relapse-free survival (bRFS), and clinical progression. The Kaplan-Meier method was used to estimate bRFS. Univariate analysis was used to examine the influence of patient- and treatment-related factors on bRFS. RESULTS AND LIMITATIONS: With respect to acute toxicity, no patients developed grade 3 gastrointestinal (GI) toxicity, and eight patients developed grade 3 genitourinary (GU) toxicity (8%). With respect to late toxicity, no patients developed grade 3 GI toxicity, and four patients (4%) developed grade 3 GU toxicity. A urethral stricture was observed in six patients (6%). The 3- and 5-yr actuarial bRFS was 93%. On univariate analysis, bRFS rates were worse when SVI (p<0.02), Gleason score > or = 4+3 (p<0.02), or negative surgical margins (p<0.02) were present. AD did not influence bRFS. Six patients had a clinical relapse. CONCLUSIONS: Adjuvant high-dose IMRT after prostatectomy is safe and bRFS is excellent.
Authors: Timothy N Showalter; Nitin Ohri; Kristopher G Teti; Kathleen A Foley; Scott W Keith; Edouard J Trabulsi; Costas D Lallas; Adam P Dicker; Jean Hoffman-Censits; Laura T Pizzi; Leonard G Gomella Journal: Int J Radiat Oncol Biol Phys Date: 2011-05-24 Impact factor: 7.038
Authors: Raymond H Mak; Daniel Hunt; Jason A Efstathiou; Niall M Heney; Christopher U Jones; Himu R Lukka; Jean-Paul Bahary; Malti Patel; Alexander Balogh; Abdenour Nabid; Mark H Leibenhaut; Daniel A Hamstra; Kevin S Roof; Robert Jeffrey Lee; Elizabeth M Gore; Howard M Sandler; William U Shipley Journal: Urol Oncol Date: 2016-07-02 Impact factor: 3.498
Authors: Fabio Zattoni; Isabel Heidegger; Veeru Kasivisvanathan; Alexander Kretschmer; Giancarlo Marra; Alessandro Magli; Felix Preisser; Derya Tilki; Igor Tsaur; Massimo Valerio; Roderick van den Bergh; Claudia Kesch; Francesco Ceci; Christian Fankhauser; Giorgio Gandaglia Journal: Front Surg Date: 2021-07-09