title: High-dose salvage intensity-modulated radiotherapy with or without androgen deprivation after radical prostatectomy for rising or persisting prostate-specific antigen: 5-year results.
abstract: BACKGROUND
  Long-term results with salvage radiotherapy (SRT) for a biochemical recurrence after radical prostatectomy (RP) are poor. It has been suggested that radiotherapy doses >70 Gy might result in improved outcome.
  
  
  OBJECTIVE
  To report on the late toxicity profile and outcome of patients treated with high-dose salvage intensity-modulated radiotherapy (HD-SIMRT) with or without androgen deprivation (AD).
  
  
  METHODS
  Between 1999 and 2008, 136 patients were referred for HD-SIMRT with or without AD. The median follow-up was 5 yr. Indications for HD-SIMRT were persisting prostate-specific antigen (PSA) or a rising PSA following RP. All patients were irradiated at a single, tertiary, academic centre. AD was initiated on the basis of seminal vesicle invasion, preprostatectomy PSA >20 ng/ml, Gleason score ≥ 4+3 (n=43), or personal preference of the referring urologist (n=54).
  
  
  METHODS
  A median 76-Gy dose was prescribed to the RP bed using intensity-modulated radiotherapy (IMRT) in all patients. AD consisted of a luteinising hormone-releasing hormone analogue for 6 mo.
  
  
  METHODS
  Univariate and multivariate analyses were used to examine the influence of patient- and treatment-related factors on late toxicity, biochemical relapse-free survival (bRFS), and clinical relapse-free survival (cRFS).
  
  
  CONCLUSIONS
  The 5-yr actuarial bRFS and cRFS were 56% and 86%, respectively. On multivariate analysis, the presence of perineural invasion at RP (hazard ratio [HR]: 6.19, p=0.001) and an increasing pre-SRT PSA (PSA 0.5 ng/ml: HR: 1; PSA 1-1.5 ng/ml: HR: 1.60, p=0.30; and PSA >1 ng/ml: HR: 2.70, p=0.02) were independent factors for a decreased bRFS. The addition of AD improved bRFS (HR: 0.33, p=0.005). On multivariate analysis, none of the variables was a predictor of cRFS. The 5-yr risk of grade 2-3 toxicity was 22% and 8% for genitourinary and gastrointestinal symptoms, respectively.
  
  
  CONCLUSIONS
  IMRT allows for safe dose escalation to 76Gy with good bRFS.
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Belgium. piet.ost@ugent.be
authors.forename: Piet
authors.initials: P
authors.lastname: Ost
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Lumen
authors.forename: An-Sofie
authors.initials: AS
authors.lastname: Goessaert
authors.forename: Valérie
authors.initials: V
authors.lastname: Fonteyne
authors.forename: Bart
authors.initials: B
authors.lastname: De Troyer
authors.forename: Filip
authors.initials: F
authors.lastname: Jacobs
authors.forename: Gert
authors.initials: G
authors.lastname: De Meerleer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen