Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis.
<h4>Purpose</h4>To 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.<h4>Methods</h4>Data fro...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2019-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0215057 |
| _version_ | 1819037078503030784 |
|---|---|
| author | Changhoon Song Sang Jun Byun Young Seok Kim Hanjong Ahn Seok-Soo Byun Choung-Soo Kim Sang Eun Lee Jae-Sung Kim |
| author_facet | Changhoon Song Sang Jun Byun Young Seok Kim Hanjong Ahn Seok-Soo Byun Choung-Soo Kim Sang Eun Lee Jae-Sung Kim |
| author_sort | Changhoon Song |
| collection | DOAJ |
| description | <h4>Purpose</h4>To 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.<h4>Methods</h4>Data 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.<h4>Results</h4>Data 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.<h4>Conclusions</h4>These 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. |
| first_indexed | 2024-12-21T08:15:42Z |
| format | Article |
| id | doaj.art-8e32035a1cf64803b8fd92c21347761d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T08:15:42Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-8e32035a1cf64803b8fd92c21347761d2022-12-21T19:10:34ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01144e021505710.1371/journal.pone.0215057Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis.Changhoon SongSang Jun ByunYoung Seok KimHanjong AhnSeok-Soo ByunChoung-Soo KimSang Eun LeeJae-Sung Kim<h4>Purpose</h4>To 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.<h4>Methods</h4>Data 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.<h4>Results</h4>Data 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.<h4>Conclusions</h4>These 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.https://doi.org/10.1371/journal.pone.0215057 |
| spellingShingle | Changhoon Song Sang Jun Byun Young Seok Kim Hanjong Ahn Seok-Soo Byun Choung-Soo Kim Sang Eun Lee Jae-Sung Kim Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis. PLoS ONE |
| title | Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis. |
| title_full | Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis. |
| title_fullStr | Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis. |
| title_full_unstemmed | Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis. |
| title_short | Elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy: A propensity score matching analysis. |
| title_sort | elective pelvic irradiation in prostate cancer patients with biochemical failure following radical prostatectomy a propensity score matching analysis |
| url | https://doi.org/10.1371/journal.pone.0215057 |
| work_keys_str_mv | AT changhoonsong electivepelvicirradiationinprostatecancerpatientswithbiochemicalfailurefollowingradicalprostatectomyapropensityscorematchinganalysis AT sangjunbyun electivepelvicirradiationinprostatecancerpatientswithbiochemicalfailurefollowingradicalprostatectomyapropensityscorematchinganalysis AT youngseokkim electivepelvicirradiationinprostatecancerpatientswithbiochemicalfailurefollowingradicalprostatectomyapropensityscorematchinganalysis AT hanjongahn electivepelvicirradiationinprostatecancerpatientswithbiochemicalfailurefollowingradicalprostatectomyapropensityscorematchinganalysis AT seoksoobyun electivepelvicirradiationinprostatecancerpatientswithbiochemicalfailurefollowingradicalprostatectomyapropensityscorematchinganalysis AT choungsookim electivepelvicirradiationinprostatecancerpatientswithbiochemicalfailurefollowingradicalprostatectomyapropensityscorematchinganalysis AT sangeunlee electivepelvicirradiationinprostatecancerpatientswithbiochemicalfailurefollowingradicalprostatectomyapropensityscorematchinganalysis AT jaesungkim electivepelvicirradiationinprostatecancerpatientswithbiochemicalfailurefollowingradicalprostatectomyapropensityscorematchinganalysis |