Abstract
PurposeTo investigate whether whole pelvic radiotherapy (WPRT) improves biochemical relapse-free survival (bRFS) vs. prostate bed radiotherapy (PBRT) in prostate cancer patients receiving salvage radiotherapy (SRT) after radical prostatectomy.MethodsData from patients with prostate cancer who underwent SRT for biochemical recurrence between 2005 and 2012 in two academic institutions were retrospectively reviewed. Patients treated with WPRT in one hospital were compared with patients treated with PBRT in the other. Propensity scoring was performed to balance the characteristics of the different treatment groups, and bRFS was compared.ResultsData from a total of 191 patients were included in the analysis (WPRT, n = 108; PBRT, n = 83). The median follow-up period was 66 months. Prior to matching, patients who received WPRT had higher pathologic Gleason scores as well as a higher incidence of pre-SRT PSA levels >0.5 ng/mL and lower rates of concurrent androgen-deprivation therapy. Propensity score matching balanced these characteristics and generated a cohort comprising 56 patients from each group. In the matched cohort, the 5 year bRFS of the WPRT group was significantly higher than that of the PBRT group (65.9 vs. 42.2%, p = 0.017). Multivariate analysis revealed that WPRT was an independent prognostic factor for bRFS (hazard ratio: 0.45, 95% confidence interval: 0.26–0.75, p = 0.002). This benefit of WPRT on bRFS was maintained in subgroup analyses, especially in patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL.ConclusionsThese data suggest that, following radical prostatectomy, elective WPRT during SRT may improve bRFS compared with PBRT in selected patients. Patients with preoperative PSA level ≤20 ng/mL or pre-SRT PSA level ≥0.4 ng/mL represent a potential subgroup who benefit most from receiving WPRT. Results of prospective randomized trials are awaited to confirm this finding.
Highlights
Data from a total of 191 patients were included in the analysis (WPRT, n = 108; prostate bed radiotherapy (PBRT), n = 83)
Multivariate analysis revealed that whole pelvic radiotherapy (WPRT) was an independent prognostic factor for biochemical relapsefree survival (bRFS)
Pelvic nodal irradiation in salvage radiotherapy for prostate cancer maintained in subgroup analyses, especially in patients with preoperative PSA level 20 ng/mL or pre-Salvage radiotherapy (SRT) PSA level 0.4 ng/mL. These data suggest that, following radical prostatectomy, elective WPRT during SRT may improve bRFS compared with PBRT in selected patients
Summary
Salvage radiotherapy (SRT) of the prostate bed in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) for the treatment of prostate cancer is associated with higher rates of biochemical control as well as lower rates of distant metastases, cancer-specific mortality, and all-cause mortality in some patients [1,2,3]. Extending the radiation field to the whole pelvis (whole pelvic radiotherapy, WPRT) in addition to androgen-deprivation therapy (ADT) improved progression-free survival among high-risk patients with an intact prostate [7] This strategy could be a rational approach to improving outcomes among patients with BCR after RP and could improve outcomes in patients with a high risk of pelvic nodal metastasis. A randomized study (RTOG 0534 SPPORT trial) is currently ongoing to investigate the role of WPRT and ADT during SRT, and several retrospective studies have been published, the conclusions are conflicting [8,9,10,11] These retrospective studies were conducted over a long period of time, beginning in the 1980s, and include inconsistencies in terms of Gleason grading, as well as diagnostic and therapeutic techniques. These data may not reflect current practice in patients treated with SRT
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