title: Need for high radiation dose (>or=70 gy) in early postoperative irradiation after radical prostatectomy: a single-institution analysis of 334 high-risk, node-negative patients.
abstract: OBJECTIVE
  To determine the clinical benefit of high-dose early adjuvant radiotherapy (EART) in high-risk prostate cancer (hrCaP) patients submitted to radical retropubic prostatectomy plus pelvic lymphadenectomy.
  
  
  METHODS
  The clinical outcome of 334 hrCaP (pT3-4 and/or positive resection margins) node-negative patients submitted to radical retropubic prostatectomy plus pelvic lymphadenectomy before 2004 was analyzed according to the EART dose delivered to the prostatic bed, <70.2 Gy (lower dose, median 66.6 Gy, n = 153) or >or=70.2 Gy (median 70.2 Gy, n = 181).
  
  
  RESULTS
  The two groups were comparable except for a significant difference in terms of median follow-up (10 vs. 7 years, respectively) owing to the gradual increase of EART doses over time. Nevertheless, median time to prostate-specific antigen (PSA) failure was almost identical, 38 and 36 months, respectively. At univariate analysis, both 5-year biochemical relapse-free survival (bRFS) and disease-free survival (DFS) were significantly higher (83% vs. 71% [p = 0.001] and 94% vs. 88% [p = 0.005], respectively) in the HD group. Multivariate analysis confirmed EART dose >or=70 Gy to be independently related to both bRFS (hazard ratio 2.5, p = 0.04) and DFS (hazard ratio 3.6, p = 0.004). Similar results were obtained after the exclusion of patients receiving any androgen deprivation. After grouping the hormone-naïve patients by postoperative PSA level the statistically significant impact of high-dose EART on both 5-year bRFS and DFS was maintained only for those with undetectable values, possibly owing to micrometastatic disease outside the irradiated area in case of detectable postoperative PSA values.
  
  
  CONCLUSIONS
  This series provides strong support for the use of EART doses >or=70 Gy after radical retropubic prostatectomy in hrCaP patients with undetectable postoperative PSA levels.
authors.affiliation: Department of Radiotherapy, Scientific Institute Hospital San Raffaele, Milan, Italy. cozzarini.cesare@hsr.it
authors.forename: Cesare
authors.initials: C
authors.lastname: Cozzarini
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Claudio
authors.initials: C
authors.lastname: Fiorino
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
authors.forename: Angelo
authors.initials: A
authors.lastname: Bolognesi
authors.forename: Luigi Filippo
authors.initials: LF
authors.lastname: Da Pozzo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Nadia
authors.initials: N
authors.lastname: Di Muzio
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000726:Androgen Antagonists / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery*; D012372:ROC Curve; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000379:methods; D012189:Retrospective Studies
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen