MP53-15 ADJUVANT VERSUS SALVAGE RADIOTHERAPY FOLLOWING RADICAL PROSTATECTOMY: META-ANALYSIS OF THE EFFECT OF COMPARATOR SALVAGE APPROACH ON STUDY CONCLUSIONS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (MP53)1 Apr 2020MP53-15 ADJUVANT VERSUS SALVAGE RADIOTHERAPY FOLLOWING RADICAL PROSTATECTOMY: META-ANALYSIS OF THE EFFECT OF COMPARATOR SALVAGE APPROACH ON STUDY CONCLUSIONS Christopher Wallis*, Zachary Klaassen, Amy Luckenbaugh, Aaron Laviana, and Bimal Bhindi Christopher Wallis*Christopher Wallis* More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Amy LuckenbaughAmy Luckenbaugh More articles by this author , Aaron LavianaAaron Laviana More articles by this author , and Bimal BhindiBimal Bhindi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000915.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Early salvage radiotherapy following radical prostatectomy is associated with improved biochemical control when compared to late treatment. Guidelines advocating adjuvant radiotherapy have relied on randomized controlled trials (RCTs) utilizing late salvage therapy while many clinicians have advocated a salvage approach based on observational data utilizing early salvage therapy. Recently, RCTs comparing adjuvant and early salvage radiotherapy have been presented. We quantitatively explored the effect of changing salvage strategies on the apparent efficacy of adjuvant radiotherapy. METHODS: We performed a systematic review of RCTs assessing the role of adjuvant radiotherapy in men following radical prostatectomy for prostate cancer. On an a priori basis, we classified trials as using an early or late salvage strategy as a comparator to adjuvant radiotherapy. We performed stratified meta-analysis based on early or late salvage strategy and assessed whether this quantitatively affected study conclusions. RESULTS: We identified seven eligible trials. Among four studies (published as full manuscripts) utilizing a late salvage strategy, use of adjuvant radiotherapy conferred a significant improvement in biochemical-recurrence free survival (hazard ratio 0.47, 95% CI 0.41 to 0.54) without significant heterogeneity between studies (I2 = 0%). In contrast, among three studies utilizing an early salvage strategy (presented only in abstract form to date), biochemical-recurrence free survival was not improved with the use of adjuvant radiotherapy (hazard ratio 1.12, 95% CI 0.88 to 1.42), again with no significant heterogeneity (I2 = 0%). There was a quantitatively significant difference in these estimates of the benefit of adjuvant radiotherapy (p<0.00001, I2 = 97.4%) (Figure), as well as a qualitative difference in the synthesized results of these studies. CONCLUSIONS: The apparent efficacy of adjuvant radiotherapy in prostate cancer depends on the nature of the salvage therapy administered to patients initially undergoing observation. Consumers of the urologic literature should consider the validity of study interventions, in addition to study design and methodology, when appraising a study and applying the results to patient care. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e788-e788 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Wallis* More articles by this author Zachary Klaassen More articles by this author Amy Luckenbaugh More articles by this author Aaron Laviana More articles by this author Bimal Bhindi More articles by this author Expand All Advertisement PDF downloadLoading ...