title: Early hypofractionated salvage radiotherapy for postprostatectomy biochemical recurrence.
abstract: BACKGROUND
  Postprostatectomy adjuvant or salvage radiotherapy, when using standard fractionation, requires 6.5 to 8 weeks of treatment. The authors report on the safety and efficacy of an expedited radiotherapy course for salvage prostate radiotherapy.
  
  
  METHODS
  A total of 108 consecutive patients were treated with salvage radiation therapy to 65 grays (Gy) in 26 fractions of 2.5 Gy. Median follow-up was 32.4 months. Median presalvage prostate-specific antigen (PSA) was 0.44 (range, 0.05-9.50). Eighteen (17%) patients received androgen deprivation after surgery or concurrently with radiation.
  
  
  RESULTS
  The actuarial freedom from biochemical failure for the entire group at 4 years was 67% ± 5.3%. An identical 67% control rate was seen at 5 years for the first 50 enrolled patients, whose median follow-up was longer at 43 months. One acute grade 3 genitourinary toxicity occurred, with no acute grade 3 gastrointestinal and no late grade 3 toxicities observed. On univariate analysis, higher Gleason score (P = .006), PSA doubling time ≤12 months (P = .03), perineural invasion (P = .06), and negative margins (P = .06) showed association with unsuccessful salvage. On multivariate analysis, higher Gleason score (P = .057) and negative margins (P = .088) retained an association with biochemical failure.
  
  
  CONCLUSIONS
  Hypofractionated radiotherapy (65 Gy in 2.5 Gy fractions in about 5 weeks) reduces the length of treatment by from 1-½ to 3 weeks relative to other treatment schedules commonly used, produces low rates of toxicity, and demonstrates encouraging efficacy at 4 to 5 years. Hypofractionation may provide a convenient, resource-efficient, and well-tolerated salvage approach for the estimated 20,000 to 35,000 US men per year experiencing biochemical recurrence after prostatectomy.
authors.affiliation: Department of Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, WI 53792, USA.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Kruser
authors.forename: David F
authors.initials: DF
authors.lastname: Jarrard
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Graf
authors.forename: Sean P
authors.initials: SP
authors.lastname: Hedican
authors.forename: David R
authors.initials: DR
authors.lastname: Paolone
authors.forename: John D
authors.initials: JD
authors.lastname: Wegenke
authors.forename: Glenn
authors.initials: G
authors.lastname: Liu
authors.forename: Heather M
authors.initials: HM
authors.lastname: Geye
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ritter
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011880:Radiotherapy Planning, Computer-Assisted; D016879:Salvage Therapy / Q000379:methods*; D014566:Urogenital System / Q000528:radiation effects
chemical_list: D017430:Prostate-Specific Antigen