title: Intraoperative radiotherapy during radical prostatectomy for intermediate-risk to locally advanced prostate cancer: treatment technique and evaluation of perioperative and functional outcome vs standard radical prostatectomy, in a matched-pair analysis.
abstract: OBJECTIVE
  To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue.
  
  
  METHODS
  Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared.
  
  
  RESULTS
  The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations.
  
  
  CONCLUSIONS
  IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated.
authors.affiliation: Division of Urology, European Institute of Oncology, University of Milan, Milan, Italy. bernardo.rocco@ieo.it
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.forename: Deliu-Victor
authors.initials: DV
authors.lastname: Matei
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Verweij
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoro
authors.forename: Andrea
authors.initials: A
authors.lastname: Vavassori
authors.forename: Juan Camillo
authors.initials: JC
authors.lastname: Ospina
authors.forename: Francisco
authors.initials: F
authors.lastname: Cedeira
authors.forename: Mario
authors.initials: M
authors.lastname: Ciocca
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
authors.forename: Ottavio
authors.initials: O
authors.lastname: de Cobelli
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004812:Epidemiologic Methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome