Abstract
Purpose: To retrospectively assess clinical outcomes and toxicity profile of prostate cancer patients treated with delayed dose-escalated image-guided salvage radiotherapy (SRT) for macroscopic local recurrence after radical prostatectomy (RP).Material and Methods: We report on a cohort of 69 consecutive patients with local recurrence after RP and no evidence of regional or distant metastasis who were referred for salvage radiotherapy between 2007 and 2016. SRT consisted of 64–66 Gy (2 Gy/fraction) to the prostatic bed followed by dose escalation to 72–74 Gy (2Gy/fraction) to the macroscopic disease. All patients received concurrent short-term androgen deprivation therapy (ADT). Biochemical recurrence-free survival (bRFS) and clinical progression-free-survival (cPFS) were depicted using Kaplan-Meier method. Multivariable Cox proportional hazards regression assessed predictors of survival outcomes. Baseline, acute, and late urinary and gastrointestinal (GI) toxicity rates were reported using CTCAE v4.03.Results: Median time from RP to SRT was 66 months (IQR: 32–124). Median pre-SRT prostate-specific antigen (PSA) was 2.7 ng/ml (IQR: 0.9–6.5). Median follow-up after SRT was 38 months (IQR: 24–66). The 3- and 5-year bRFS were 58 and 44%, respectively. The 3- and 5-year cPFS were 91 and 76%, respectively. Median time from SRT to clinical disease progression was 102 months (IQR 77.5–165). At baseline, 3 patients (4%) had grade 3 urinary symptoms. Six patients (9%) developed acute and six patients (9%) developed late grade 3 urinary toxicity. Five patients (7%) had acute grade 2 GI toxicity. No acute grade 3 GI toxicity was reported. Late grade 3 GI toxicity was reported in one patient (1.5%).Conclusions: Delayed dose-escalated SRT combined with short-course ADT for macroscopic LR after RP was associated with 44% bRFS and 76% cPFS at 5 years. Albeit improved patient stratification is warranted, these data suggest that delayed SRT provides inferior tumor control compared to early intervention.
Highlights
About 20–40% of all localized prostate cancer patients undergoing radical prostatectomy (RP) develop biochemical recurrence [1, 2]
The purpose of the current study was to evaluate oncologic outcomes and toxicity rates in a cohort of patients treated with delayed dose-escalated image-guided salvage radiotherapy (SRT) for macroscopic local recurrence (LR) after RP
Following approval of institutional and regional ethical review boards, we reviewed charts of 69 consecutive patients who received image-guided SRT after RP due to isolated LR in the prostatic bed between 2007 and 2016 at our Department of Radiation Oncology
Summary
About 20–40% of all localized prostate cancer patients undergoing radical prostatectomy (RP) develop biochemical recurrence [1, 2]. In the absence of overt distant metastasis, salvage radiotherapy (SRT) to the prostatic bed is commonly offered as a potential curative treatment for patients with biochemical or manifested local recurrence (LR). Several studies have shown that SRT efficacy is highly dependent on the pre-salvage prostate-specific antigen (PSA) level [3,4,5]. Many urologists including at our institution are reluctant to offer early SRT in the absence of radiologically confirmed local disease. The two main arguments favoring this approach include lack of conclusive overall survival benefits from prospective clinical trials and a potential increased risk of worsened functional outcomes [6].
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