High-Dose Adjuvant Radiotherapy After Radical Prostatectomy With or Without Androgen Deprivation Therapy

Purpose To retrospectively evaluate the outcome and toxicity in patients receiving high-dose (>69 Gy) adjuvant radiotherapy (HD-ART) and the impact of androgen deprivation therapy (ADT). Methods and Materials Between 1999 and 2008, 225 node-negative patients were referred for HD-ART with or witho...

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Veröffentlicht in:International journal of radiation oncology, biology, physics biology, physics, 2012-07, Vol.83 (3), p.960-965
Hauptverfasser: Ost, Piet, M.D., Ph.D, Cozzarini, Cesare, M.D, De Meerleer, Gert, M.D., Ph.D, Fiorino, Claudio, Ph.D, De Potter, Bruno, B.A, Briganti, Alberto, M.D, Nagler, Evi V.T., M.D, Montorsi, Francesco, M.D, Fonteyne, Valérie, M.D., Ph.D, Di Muzio, Nadia, M.D
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Sprache:eng
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Zusammenfassung:Purpose To retrospectively evaluate the outcome and toxicity in patients receiving high-dose (>69 Gy) adjuvant radiotherapy (HD-ART) and the impact of androgen deprivation therapy (ADT). Methods and Materials Between 1999 and 2008, 225 node-negative patients were referred for HD-ART with or without ADT to two large academic institutions. Indications for HD-ART were extracapsular extension, seminal vesicle invasion (SVI), and/or positive surgical margins at radical prostatectomy (RP). A dose of at least 69.1 Gy was prescribed to the prostate bed and seminal vesicle bed. The ADT consisted of a luteinizing hormone–releasing hormone analog. The duration and indication of ADT was left at the discretion of the treating physician. The effect of HD-ART and ADT on biochemical (bRFS) and clinical (cRFS) relapse-free survival was examined through univariate and multivariate analysis, with correction for known patient- and treatment-related variables. Interaction terms were introduced to evaluate effect modification. Results After a median follow-up time of 5 years, the 7-year bRFS and cRFS were 84% and 88%, respectively. On multivariate analysis, the addition of ADT was independently associated with an improved bRFS (hazard ratio [HR] 0.4, p = 0.02) and cRFS (HR 0.2, p = 0.008). Higher Gleason scores and SVI were associated with decreased bRFS and cRFS. A lymphadenectomy at the time of RP independently improved cRFS (HR 0.09, p = 0.009). The 7-year probability of late Grade 2–3 toxicity was 29% and 5% for genitourinary (GU) and gastrointestinal (GI) symptoms, respectively. The absolute incidence of Grade 3 toxicity was
ISSN:0360-3016
1879-355X
DOI:10.1016/j.ijrobp.2011.09.007