title: Conformal postoperative radiotherapy in patients with positive resection margins and/or pT3-4 prostate adenocarcinoma.
abstract: OBJECTIVE
  To evaluate outcome and toxicity of high-dose conformal radiotherapy (RT) after radical prostatectomy.
  
  
  METHODS
  Between August 1998 and December 2007, 182 consecutive patients with positive resection margins and/or pT3-4, node-negative prostate adenocarcinoma underwent postoperative conformal RT. The prescribed median dose to the prostate/seminal vesicle bed was 66.6 Gy (range 50-70). Hormone therapy (a luteinizing hormone-releasing hormone analogue and/or antiandrogen) was administered to 110/182 (60.5%) patients with high-risk features. Biochemical relapse was defined as an increase of more than 0.2 ng/mL over the lowest postoperative prostate-specific antigen (PSA) value measured on 3 occasions, each at least 2 weeks apart.
  
  
  RESULTS
  Median follow-up was 55.6 months (range 7.6-141.9 months). The 3- and 5-year probability of biochemical relapse-free survival were 87% and 81%, respectively. In univariate analysis, more advanced T stages, preoperative PSA values ≥10 ng/mL, and RT doses <70 Gy were significant factors for biochemical relapse. Pre-RT PSA values >0.2 ng/mL were significant for distant metastases. In multivariate analysis, risk factors for biochemical relapse were higher preoperative and pre-RT PSA values, hormone therapy for under 402 days and RT doses of <70 Gy. Higher pre-RT PSA values were the only independent predictor of distant metastases. Acute genitourinary (GU) and gastrointestinal (GI) toxicities occurred in 72 (39.6%) and 91 (50%) patients, respectively. There were 2 cases of Grade III GI toxicity but no cases of Grade IV. Late GU and GI toxicities occurred in 28 (15.4%) and 14 (7.7%) patients, respectively: 11 cases of Grade III toxicity: 1 GI (anal stenosis) and 10 GU, all urethral strictures requiring endoscopic urethrotomy.
  
  
  CONCLUSIONS
  Postoperative high-dose conformal RT in patients with high-risk features was associated with a low risk of biochemical relapse as well as minimal morbidity.
authors.affiliation: Institute of Radiation Oncology, General Hospital and Perugia University, Perugia, Italy. ritabellavita@libero.it
authors.forename: Rita
authors.initials: R
authors.lastname: Bellavita
authors.forename: Michela
authors.initials: M
authors.lastname: Massetti
authors.forename: Iosief
authors.initials: I
authors.lastname: Abraha
authors.forename: Marco
authors.initials: M
authors.lastname: Lupattelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Mearini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Falcinelli
authors.forename: Alessia
authors.initials: A
authors.lastname: Farneti
authors.forename: Isabella
authors.initials: I
authors.lastname: Palumbo
authors.forename: Massimo
authors.initials: M
authors.lastname: Porena
authors.forename: Cynthia
authors.initials: C
authors.lastname: Aristei
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000368:Aged; D000704:Analysis of Variance; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011184:Postoperative Period; D011467:Prostate / Q000528:radiation effects; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012189:Retrospective Studies; D012669:Seminal Vesicles / Q000528:radiation effects
chemical_list: D017430:Prostate-Specific Antigen