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Early hypofractionated salvage radiotherapy for postprostatectomy biochemical recurrence
Article first published online: 14 DEC 2010
Copyright © 2010 American Cancer Society
Volume 117, Issue 12, pages 2629–2636, 15 June 2011
How to Cite
Kruser, T. J., Jarrard, D. F., Graf, A. K., Hedican, S. P., Paolone, D. R., Wegenke, J. D., Liu, G., Geye, H. M. and Ritter, M. A. (2011), Early hypofractionated salvage radiotherapy for postprostatectomy biochemical recurrence. Cancer, 117: 2629–2636. doi: 10.1002/cncr.25824
- Issue published online: 7 JUN 2011
- Article first published online: 14 DEC 2010
- Manuscript Accepted: 2 NOV 2010
- Manuscript Revised: 25 OCT 2010
- Manuscript Received: 28 AUG 2010
- salvage radiotherapy;
- prostate cancer;
- prognostic factors;
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.
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.
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.
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.