title: Salvage intensity-modulated radiotherapy for rising PSA after radical prostatectomy.
abstract: BACKGROUND
  The aim was to prospectively evaluate both acute and late toxicity and biochemical non-evidence of disease (bNED) in patients treated with salvage intensity-modulated radiotherapy (IMRT) +/- androgen deprivation (AD) for biochemical relapse after radical prostatectomy (RP).
  
  
  METHODS
  IMRT was prescribed to a mean prescription dose to the planning target volume (PTV) of 75 Gy to be delivered in 37 fractions of 2 Gy. In total, 135 patients were treated with IMRT. Median age was 64 years. Median PSA level was 0.8 ng/ml. AD was initiated in 94 patients. Indications were perineural invasion, seminal vesicle invasion or Gleason score > or = 8 at RP. (1) Acute toxicity (n = 135). All patients were available for this analysis. Acute toxicity was scored using an in-house developed scoring system. (2) Late toxicity (n = 68). Only patients with a follow-up of at least 18 months were considered for late toxicity analysis. The RILIT score was used to register gastro-intestinal (GI) toxicity. An in-house developed scale was used to register genito-urinary (GU) toxicity. (3) bNED (n = 87). For bNED, all AD-naive patients (n = 38) together with the AD-positive patients with a follow-up > or = 18 months (n = 49) were considered. Factors influencing the results of salvage treatment were analyzed.
  
  
  RESULTS
  (1) Acute toxicity (n = 135). No patient developed grade 3 GI toxicity. We observed grade 2 toxicity in 20 patients. Four patients developed grade 3 GU toxicity. (2) Late toxicity (n = 68). One patient developed grade 3 rectal blood loss. One patient developed grade 3 anal pain (anal fissure). We observed grade 2 GI toxicity in 9 patients. Two patients developed grade 3GU toxicity. Twenty-one patients developed grade 2 GU toxicity. We observed an urethral stricture in 5 patients. (3) bNED (n = 87). The 3- and 5-year bNED was 67%. Gleason score at RP, perineural invasion and capsular perforation were significant predictors for bNED. PSA before IMRT (<1.0 vs. 1.0 ng/ml) showed a trend in predicting bNED (p = 0.08).
  
  
  CONCLUSIONS
  IMRT to 75Gy+/-AD can be delivered with low levels of acute and late toxicity. In patients without perineural invasion and capsular invasion and with a Gleason score > or = 7 (3 + 4), IMRT offers very good 5-years bNED.
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, Belgium. gert.demeerleer@uzgent.be
authors.forename: Gert
authors.initials: G
authors.lastname: De Meerleer
authors.forename: Valérie
authors.initials: V
authors.lastname: Fonteyne
authors.forename: Sabine
authors.initials: S
authors.lastname: Meersschout
authors.forename: Caroline
authors.initials: C
authors.lastname: Van den Broecke
authors.forename: Geert
authors.initials: G
authors.lastname: Villeirs
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Lumen
authors.forename: Piet
authors.initials: P
authors.lastname: Ost
authors.forename: Katrien
authors.initials: K
authors.lastname: Vandecasteele
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Neve
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D016879:Salvage Therapy / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen