Improved toxicity profile following high-dose postprostatectomy salvage radiation therapy with intensity-modulated radiation therapy Journal Article


Authors: Goenka, A.; Magsanoc, J. M.; Pei, X.; Schechter, M.; Kollmeier, M.; Cox, B.; Scardino, P. T.; Eastham, J. A.; Zelefsky, M. J.
Article Title: Improved toxicity profile following high-dose postprostatectomy salvage radiation therapy with intensity-modulated radiation therapy
Abstract: Background: With salvage radiation therapy (SRT) in the postprostatectomy setting, the need to deliver sufficient radiation doses to achieve a high probability of tumor control is balanced with the risk of increased toxicity. Intensity-modulated radiation therapy (IMRT) in the postprostatectomy salvage setting is gaining interest as a treatment strategy. Objective: Compare acute and late toxicities in patients treated with IMRT and three-dimensional conformal radiation therapy (3D-CRT) in the postprostatectomy salvage setting. Design, setting, and participants: A total of 285 patients who were treated at our institution between 1988 and 2007 with SRT after radical prostatectomy for biochemical recurrence were identified. All medical records were reviewed and toxicity recorded. Median follow-up was 60 mo. Intervention: All patients were treated with SRT with either 3D-CRT (n = 109) or IMRT (n = 176). A total of 205 patients (72%) were treated with doses ≥70 Gy. Measurements: Late gastrointestinal (GI) and genitourinary (GU) toxicities were recorded using the Common Terminology Criteria for Adverse Events v. 3.0 definition. Results and limitations: The 5-yr actuarial rates of late grade ≥2 GI and GU toxicity were 5.2% and 17.0%, respectively. IMRT was independently associated with a reduction in grade ≥2 GI toxicity compared with 3D-CRT (5-yr IMRT, 1.9%; 5-yr 3D-CRT, 10.2%; p = 0.02). IMRT was not associated with a reduction in risk of grade ≥2 GU toxicity (5-yr IMRT, 16.8%; 5-yr 3D-CRT, 15.8%; p = 0.86), urinary incontinence (5-yr IMRT, 13.6%; 5-yr 3D-CRT, 7.9%; p = 0.25), or grade 3 erectile dysfunction (5-yr IMRT, 26%; 5-yr 3D-CRT, 30%; p = 0.82). Of patients who developed late grade ≥2 GI or GU toxicity, 38% and 44%, respectively, experienced resolution of their symptoms prior to the last follow-up. Conclusions: Our experience with high-dose IMRT in the postprostatectomy salvage setting demonstrates that the treatment can be delivered safely with an associated reduction in late GI toxicity. © 2011 European Association of Urology.
Keywords: adult; controlled study; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; retrospective studies; major clinical study; intensity modulated radiation therapy; salvage therapy; cancer adjuvant therapy; cancer radiotherapy; postoperative care; radiation dose; radiotherapy, adjuvant; follow up; prostate specific antigen; nephrotoxicity; neoplasm recurrence, local; gastrointestinal symptom; risk factors; medical record review; time factors; risk assessment; radiation dosage; prostate cancer; prostate-specific antigen; prostatic neoplasms; gastrointestinal toxicity; radiotherapy, intensity-modulated; urine incontinence; prostatectomy; radiation injuries; new york city; radiotherapy, conformal; antiandrogen; acute toxicity; regression analysis; risk reduction; urogenital tract disease; erectile dysfunction; androgen deprivation therapy; urinary incontinence; intensity-modulated radiation therapy; gastrointestinal diseases; kaplan-meier estimate; urethra stricture; postprostatectomy salvage radiation therapy; urinary strictures; urinary toxicity; chronic toxicity; three dimensional conformal radiation therapy; male urogenital diseases
Journal Title: European Urology
Volume: 60
Issue: 6
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2011-12-01
Start Page: 1142
End Page: 1148
Language: English
DOI: 10.1016/j.eururo.2011.08.006
PROVIDER: scopus
PUBMED: 21855208
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 9 December 2011" - "CODEN: EUURA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Brett Wayne Cox
    62 Cox
  2. Michael J Zelefsky
    616 Zelefsky
  3. Peter T Scardino
    621 Scardino
  4. Marisa A Kollmeier
    144 Kollmeier
  5. Anuj Goenka
    18 Goenka
  6. James Eastham
    426 Eastham
  7. Xin Pei
    98 Pei