A Multi-Institutional Matched-Control Analysis of Adjuvant and Salvage Postoperative Radiation Therapy for pT3-4N0 Prostate Cancer - 08/08/11
, Alexandra L. Hanlon c, Thomas M. Pisansky e, Howard M. Sandler f, Deborah A. Kuban i, Charles N. Catton l, Jeff M. Michalski m, Michael J. Zelefsky n, Patrick A. Kupelian p, Daniel W. Lin r, Mitchell S. Anscher s, Kevin M. Slawin j, Claus G. Roehrborn k, Jeffrey D. Forman g, Stanley L. Liauw t, Larry L. Kestin h, Theodore L. DeWeese u, Peter T. Scardino o, Andrew J. Stephenson q, Alan Pollack d
Reprint requests: Richard K. Valicenti, MD, Department of Radiation Oncology, Thomas Jefferson University, 111 S. 11th St, Philadelphia, PA 19107Résumé |
Objectives |
It is unclear whether postoperative salvage radiation therapy (SRT) and early adjuvant radiotherapy (ART) after radical prostatectomy lead to equivalent long-term tumor control. We studied a group of patients undergoing ART by comparing them with a matched control group undergoing SRT after biochemical failure.
Methods |
Using a multi-institutional database of 2299 patients, 449 patients with pT3-4N0 disease were eligible for inclusion, including 211 patients receiving ART and 238 patients receiving SRT. Patients were matched in a 1:1 ratio according to preoperative prostate-specific antigen Gleason score, seminal vesicle invasion, surgical margin status, and follow-up from date of surgery.
Results |
A total of 192 patients were matched (96:96). The median follow-up was 94 months from surgery and 73 months from RT completion. There was a significant reduction in biochemical failure with ART compared with SRT. The 5-year freedom from biochemical failure (FFBF) from surgery was 75% after ART, compared with 66% for SRT (hazard ratio [HR] = 1.6, P = .049). The 5-year FFBF from the end of RT was 73% after ART, compared with 50% after SRT (HR = 2.3, log rank [LR] P = .0007). From the end of RT, SRT and Gleason score ≥8 were independent predictors of diminished FFBF. From the date of surgery, Gleason score ≥8 was a significant predictor of FFBF.
Conclusions |
Early ART for pT3-4N0 prostate cancer significantly reduces the risk of long-term biochemical progression after radical prostatectomy compared with SRT. Gleason score ≥8 was the only factor on multivariate analysis associated with metastasic progression.
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Vol 72 - N° 6
P. 1298-1302 - décembre 2008 Retour au numéro
Article précédent
- Use of Nonsteroidal Anti-inflammatory Drugs After Radical Retropubic Prostatectomy: A Prospective, Randomized Trial
- Evangelos M. Mazaris, Ioannis Varkarakis, Michael Chrisofos, Andreas Skolarikos, Konstantinos Ioannidis, Athanasios Dellis, Athanasios Papatsoris, Charalambos Deliveliotis
- Editorial Comment
- Mack Roach
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