[Radiotherapy after radical prostatectomy: description, outcome and prognostic factors in and emerging practice].
OBJECTIVE
Recently it has been reported in the EORTC (European Organisation for Research and Treatment of Cancer) trial 22911 and the SWOG (Southwest Oncology Group) 8794, the evidence that radiotherapy (RT) is an effective treatment after the prostatectomy in patients with high risk of biochemical failure. We analyze predictor factors of biochemical relapse and the potential benefits induced by rescue treatment are the main purposes of our study.


METHODS
From 1993 to 2003, 597 prostatectomy were followed at Hospital Universitario Gregorio Marañón de Madrid, identifying 166 patients (p) (28%) of biochemical failure (defined as PSA > or = 0'5 ng/ml, including post-surgical persistent values). 42 p received RT (78% due to delayed PSA relapse). The median total dose was 66 Gy [60-74].


RESULTS
Clinical variables: Median age: 68 years [49-80], median PSA at diagnosis: 29,8 ng/ml [2,6475]; presurgical Gleason > or = 7: 65%. Histological variables: Prostatectomy induces stage migration to superior T (pT3-T4: 95%) and Gleason categories (> or =7: 81%). 83% of relapsed p had positive margins and 90% had pT3-pT4.


METHODS
median time to biochemical recurrence was 22,2 months. Median time interval between biochemical failure and RT was 10,5 months. Overall survival (5 years) was 86 +/- 6%. Freedom-from-biochemical failure at 5 years was 76 +/- 4%. RT had poor survival in p with PSA > 2 ng/ml pre-RT (p = 0.03), post-prostatectomy persistant disease (p = 0.05) and Gleason score > or = 7 (p = 0.01). No increased grade 3-4 uro-rectal toxicity was observed.


CONCLUSIONS
RT after prostatectomy improves freedom-from-biochemical failure in p with PSA values below 2 ng/ml. In our experience, Gleason score > or = 7 is a negative predictor of response. There is no severe toxicity in our series. Improvement of the staging presurgery, the role of the adjuvant androgen deprivation and selection of patients for adjuvant RT focus current studies on treatment after prostatectomy.
de Torres Olombrada
Ma Victoria
MV
Servicio de Oncología Radioterápica, Hospital General Universitario Gregorio Marañón, Madrid, España. marividetorres@yahoo.es
González San Segundo
Carmen
C
Santos Miranda
Juan A
JA
Ibáñez Villoslada
Carmen
C
Martínez Salamanca
Juan I
JI
Herranz Amo
Felipe
F
Calvo Manuel
Felipe A
FA
D000368:Aged; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome