title: ACR appropriateness criteria postradical prostatectomy irradiation in prostate cancer.
abstract: The role of postradical prostatectomy radiation therapy continues to evolve under the influence of new clinical data. In particular, 2 recently published or updated randomized trials have prompted a reevaluation of its utility in the adjuvant and salvage setting. The Southwest Oncology Group 8794 trial randomized 473 patients with stage T3a-T3b disease to adjuvant radiotherapy versus observation. With a median follow-up of 12.7 years, this trial demonstrates an improvement in metastasis-free (93/214 vs. 114/211, P = 0.016) and overall survival (88 vs. 110 deaths, P = 0.023) favoring adjuvant radiotherapy. The European Organization for Research and Treatment of Cancer 22911 study of 972 patients with at least 1 "high risk" feature at surgery (extracapsular extension, positive surgical margins, seminal vesicle involvement) randomized to immediate adjuvant radiotherapy (60 Gy) versus observation. The freedom from biochemical failure at 5 years was 53% in the observation alone group versus 74% in the adjuvant radiotherapy group (P < 0.0001). This review summarizes the current evidence-based literature supporting the use of postradical prostatectomy radiation therapy in various common clinical settings and will serve to illustrate the appropriateness of postoperative radiotherapy by reviewing its implementation in a variety of commonly occurring clinical scenarios. It is intended to serve both as a guideline for the practicing radiation oncologist and a resource for further learning.
authors.affiliation: Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354–2871, USA. crossi@dominion.llumc.edu
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Rossi
authors.forename: I-Chow
authors.initials: IC
authors.lastname: Joe Hsu
authors.forename: May
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: V Elayne
authors.initials: VE
authors.lastname: Arterbery
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.forename: Noah M
authors.initials: NM
authors.lastname: Hahn
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.forename: Seth A
authors.initials: SA
authors.lastname: Rosenthal
authors.forename: Gregory
authors.initials: G
authors.lastname: Merrick
mesh_terms: D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D012955:Societies, Medical; D014481:United States