Tolerance and early outcome results of postprostatectomy three-dimensional conformal radiotherapy Journal Article
| Authors: | Zelefsky, M. J.; Aschkenasy, E.; Kelsen, S.; Leibel, S. A. |
| Article Title: | Tolerance and early outcome results of postprostatectomy three-dimensional conformal radiotherapy |
| Abstract: | Purpose: Three-dimensional conformal radiotherapy (3D-CRT) has been associated with a reduction in acute and late toxicity among patients treated for localized prostatic cancer. The purpose of this study is to assess the acute and late toxicity of 3D-CRT delivered to patients in the postprostatectomy setting and to analyze which factors predict for durable biochemical control in this group of patients. Methods and Materials: Between 1988 and 1994, 42 patients were treated after prostatectomy with three- dimensional conformal radiotherapy. The median time from prostatectomy to radiotherapy was 11 months. Indications for treatment included a rising serum PSA level in 28 patients (65%) and positive surgical margins without a rising PSA level in 14 (35%). Twenty-five patients (60%) had pathologic stage T3 disease, and 32 (74%) had tumor at or close to the surgical margins. The median dose was 64.8 Gy, and the median follow-up time was 2 years. Results: 3D-CRT in the postprostatectomy setting was well tolerated. Three patients (7%) experienced Grade II acute genitourinary toxicity and nine patients (21%) experienced Grade II acute gastrointestinal toxicity during treatment. No patient experienced Grade III or higher acute morbidity. The 2-year actuarial risk for Grade II late genitourinary and gastrointestinal late complications were 5 and 9%, respectively. In patients with existing incontinence, the incidence of worsening stress incontinence 6 months after treatment was 17%, which resolved within 12 months to its preradiotherapy level in four of six cases (66%). The overall 2-year postirradiation PSA relapse-free survival rate was 53%. The 2-year PSA relapse-free survival was 66% for patients with undetectable PSA levels in the immediate postoperative period compared to 26% for those with detectable levels of PSA after surgery (p < 0.006). Furthermore, for patients with preradiotherapy PSA levels of ≤ 1.0 ng/ml, the 2-year PSA relapse-free survival was 74% compared to 17% of those with preradiotherapy PSA levels of >1.0 ng/ml (p < 0.002). The resection margin status, presence of seminal vesicle involvement, Gleason Score, and the preprostatectomy PSA level did not impact on PSA relapse-five survival. A Cox proportional hazards regression analysis demonstrated that a preradiotherapy PSA value of >1 ng/ml (p < 0.002) was the most important covariate predicting for a rising PSA after radiotherapy. Conclusions: After prostatectomy, three-dimensional conformal radiotherapy is associated with minimal treatment-related morbidity. Patients with postprostatectomy, preradiotherapy PSA levels ≤ 1.0 ng/ml, and those patients who had undetectable PSA levels in the immediate postoperative period are more likely to benefit from local adjuvant therapy. |
| Keywords: | adult; clinical article; aged; middle aged; cancer surgery; clinical trial; adjuvant therapy; cancer adjuvant therapy; cancer radiotherapy; combined modality therapy; prostate specific antigen; morbidity; prostate cancer; prostate-specific antigen; prostatic neoplasms; gastrointestinal toxicity; prostatectomy; radiation injuries; urogenital tract disease; urinary incontinence; radiotherapy, computer-assisted; three-dimensional conformal radiotherapy; stress incontinence; humans; human; male; priority journal; article; prostate-specific antigert |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 39 |
| Issue: | 2 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 1997-09-01 |
| Start Page: | 327 |
| End Page: | 333 |
| Language: | English |
| PUBMED: | 9308935 |
| PROVIDER: | scopus |
| DOI: | 10.1016/S0360-3016(97)00056-4 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 17 March 2017 -- Source: Scopus |
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