Early hypofractionated salvage radiotherapy for postprostatectomy biochemical recurrence

• Published in: Cancer Vol. 117; no. 12; pp. 2629 - 2636
• Main Authors: Kruser, Tim J., Jarrard, David F., Graf, Andrew K., Hedican, Sean P., Paolone, David R., Wegenke, John D., Liu, Glenn, Geye, Heather M., Ritter, Mark A.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15-06-2011; Wiley-Blackwell
• Subjects: Aged; Biological and medical sciences; Combined Modality Therapy; Dose Fractionation; Humans; hypofractionation; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - radiotherapy; Nephrology. Urinary tract diseases; postprostatectomy; prognostic factors; prostate cancer; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiotherapy Planning, Computer-Assisted; salvage radiotherapy; Salvage Therapy - methods; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urogenital System - radiation effects; Urinary system disease; Prognosis; Prostate disease; postprostatectomy; prognostic factors; Malignant tumor; Radiotherapy; Biochemical recurrence; Fractionated dose; Hypofractionation; Cancerology; salvage radiotherapy; Early; Salvage treatment; Male genital diseases; Prostate cancer; Cancer
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.25824

BACKGROUND:
Postprostatectomy adjuvant or salvage radiotherapy, when using standard fractionation, requires 6.5 to 8 weeks of treatment. The authors report on the safety and efficacy of an expedited radiotherapy course for salvage prostate radiotherapy.
METHODS:
A total of 108 consecutive patients were treated with salvage radiation therapy to 65 grays (Gy) in 26 fractions of 2.5 Gy. Median follow‐up was 32.4 months. Median presalvage prostate‐specific antigen (PSA) was 0.44 (range, 0.05‐9.50). Eighteen (17%) patients received androgen deprivation after surgery or concurrently with radiation.
RESULTS:
The actuarial freedom from biochemical failure for the entire group at 4 years was 67% ± 5.3%. An identical 67% control rate was seen at 5 years for the first 50 enrolled patients, whose median follow‐up was longer at 43 months. One acute grade 3 genitourinary toxicity occurred, with no acute grade 3 gastrointestinal and no late grade 3 toxicities observed. On univariate analysis, higher Gleason score (P = .006), PSA doubling time ≤12 months (P = .03), perineural invasion (P = .06), and negative margins (P = .06) showed association with unsuccessful salvage. On multivariate analysis, higher Gleason score (P = .057) and negative margins (P = .088) retained an association with biochemical failure.
CONCLUSIONS:
Hypofractionated radiotherapy (65 Gy in 2.5 Gy fractions in about 5 weeks) reduces the length of treatment by from 1‐½ to 3 weeks relative to other treatment schedules commonly used, produces low rates of toxicity, and demonstrates encouraging efficacy at 4 to 5 years. Hypofractionation may provide a convenient, resource‐efficient, and well‐tolerated salvage approach for the estimated 20,000 to 35,000 US men per year experiencing biochemical recurrence after prostatectomy. Cancer 2011. © 2010 American Cancer Society.
The authors report on toxicity and efficacy of an expedited, hypofractionated course of radiotherapy for patients demonstrating biochemical recurrence after radical prostatectomy (RP). The results presented suggest this may represent a safe, effective, and resource‐efficient treatment for the estimated 20,000 to 35,000 men experiencing biochemical recurrence after RP each year in the United States.