Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy
Abstract Background Adjuvant (ART) and salvage radiotherapy (SRT) are two common concepts to enhance biochemical relapse free survival (BCRFS) in patients with prostate cancer (PC). We analyzed differences in outcome between ART and SRT in patients with steep decline of PSA-levels after surgery to c...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13014-019-1391-0 |
| _version_ | 1818656729905233920 |
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| author | Marco M. E. Vogel Kerstin A. Kessel Kilian Schiller Michal Devecka Jürgen E. Gschwend Wilko Weichert Jan J. Wilkens Stephanie E. Combs |
| author_facet | Marco M. E. Vogel Kerstin A. Kessel Kilian Schiller Michal Devecka Jürgen E. Gschwend Wilko Weichert Jan J. Wilkens Stephanie E. Combs |
| author_sort | Marco M. E. Vogel |
| collection | DOAJ |
| description | Abstract Background Adjuvant (ART) and salvage radiotherapy (SRT) are two common concepts to enhance biochemical relapse free survival (BCRFS) in patients with prostate cancer (PC). We analyzed differences in outcome between ART and SRT in patients with steep decline of PSA-levels after surgery to compare outcome. Methods We evaluated 253 patients treated with postoperative RT with a median age of 66 years (range 42–85 years) treated between 2004 and 2014. Patients with additive radiotherapy due to PSA persistence and patients in the SRT group, who did not achieve a postoperative PSA level <0.1 ng/mL were excluded. Hence, data of 179 patients was evaluated. We used propensity score matching to build homogenous groups. A Cox regression model was used to determine differences between treatment options. Median follow-up was 32.5 months (range 1.4–128.0 months). Results Early SRT at PSA levels <0.3 ng/mL was associated with significant longer BCRFS than late SRT (HR: 0.32, 95%-CI: 0.14–0.75, p = 0.009). Multiple Cox regression showed pre-RT PSA level, tumor stage, and Gleason score as predictive factors for biochemical relapse. In the overall group, patients treated with either ART or early SRT showed no significant difference in BCRFS (HR: 0.17, 95%-CI: 0.02–1.44, p = 0.1). In patients with locally advanced PC (pT3/4) BCRFS was similar in both groups as well (HR: 0.21, 95%-CI:0.02–1.79, p = 0.15). Conclusion For patients with PSA-triggered follow-up, close observation is essential and early initiation of local treatment at low PSA levels (<0.3 ng/mL) is beneficial. Our data suggest, that SRT administered at early PSA rise might be equieffective to postoperative ART in patients with locally advanced PC. However, the individual treatment decision must be based on any adverse risk factors and the patients’ postoperative clinical condition. Study registration The present work is approved by the Ethics Commission of the Technical University of Munich (TUM) and is registered with the project number 320/14. |
| first_indexed | 2024-12-17T03:30:13Z |
| format | Article |
| id | doaj.art-3a9d64b5db374494a24745a314952816 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-17T03:30:13Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-3a9d64b5db374494a24745a3149528162022-12-21T22:05:17ZengBMCRadiation Oncology1748-717X2019-11-0114111210.1186/s13014-019-1391-0Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomyMarco M. E. Vogel0Kerstin A. Kessel1Kilian Schiller2Michal Devecka3Jürgen E. Gschwend4Wilko Weichert5Jan J. Wilkens6Stephanie E. Combs7Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Urology, Klinikum rechts der Isar, Technical University of Munich (TUM)Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site MunichDepartment of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM)Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM)Abstract Background Adjuvant (ART) and salvage radiotherapy (SRT) are two common concepts to enhance biochemical relapse free survival (BCRFS) in patients with prostate cancer (PC). We analyzed differences in outcome between ART and SRT in patients with steep decline of PSA-levels after surgery to compare outcome. Methods We evaluated 253 patients treated with postoperative RT with a median age of 66 years (range 42–85 years) treated between 2004 and 2014. Patients with additive radiotherapy due to PSA persistence and patients in the SRT group, who did not achieve a postoperative PSA level <0.1 ng/mL were excluded. Hence, data of 179 patients was evaluated. We used propensity score matching to build homogenous groups. A Cox regression model was used to determine differences between treatment options. Median follow-up was 32.5 months (range 1.4–128.0 months). Results Early SRT at PSA levels <0.3 ng/mL was associated with significant longer BCRFS than late SRT (HR: 0.32, 95%-CI: 0.14–0.75, p = 0.009). Multiple Cox regression showed pre-RT PSA level, tumor stage, and Gleason score as predictive factors for biochemical relapse. In the overall group, patients treated with either ART or early SRT showed no significant difference in BCRFS (HR: 0.17, 95%-CI: 0.02–1.44, p = 0.1). In patients with locally advanced PC (pT3/4) BCRFS was similar in both groups as well (HR: 0.21, 95%-CI:0.02–1.79, p = 0.15). Conclusion For patients with PSA-triggered follow-up, close observation is essential and early initiation of local treatment at low PSA levels (<0.3 ng/mL) is beneficial. Our data suggest, that SRT administered at early PSA rise might be equieffective to postoperative ART in patients with locally advanced PC. However, the individual treatment decision must be based on any adverse risk factors and the patients’ postoperative clinical condition. Study registration The present work is approved by the Ethics Commission of the Technical University of Munich (TUM) and is registered with the project number 320/14.http://link.springer.com/article/10.1186/s13014-019-1391-0Prostatic carcinomaPostoperative radiation therapyBiochemical relapseBiochemical relapse free survival timeARTSRT |
| spellingShingle | Marco M. E. Vogel Kerstin A. Kessel Kilian Schiller Michal Devecka Jürgen E. Gschwend Wilko Weichert Jan J. Wilkens Stephanie E. Combs Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy Radiation Oncology Prostatic carcinoma Postoperative radiation therapy Biochemical relapse Biochemical relapse free survival time ART SRT |
| title | Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy |
| title_full | Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy |
| title_fullStr | Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy |
| title_full_unstemmed | Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy |
| title_short | Adjuvant versus early salvage radiotherapy: outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy |
| title_sort | adjuvant versus early salvage radiotherapy outcome of patients with prostate cancer treated with postoperative radiotherapy after radical prostatectomy |
| topic | Prostatic carcinoma Postoperative radiation therapy Biochemical relapse Biochemical relapse free survival time ART SRT |
| url | http://link.springer.com/article/10.1186/s13014-019-1391-0 |
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