title: Exclusive image guided IMRT vs. radical prostatectomy followed by postoperative IMRT for localized prostate cancer: a matched-pair analysis based on risk-groups.
abstract: BACKGROUND
  To investigate whether patients treated for a localized prostate cancer (PCa) require a radical prostatectomy followed by postoperative radiotherapy or exclusive radiotherapy, in the modern era of image guided IMRT.
  
  
  METHODS
  178 patients with PCa were referred for daily exclusive image guided IMRT (IG-IMRT) using an on-line 3D ultra-sound based system and 69 patients were referred for postoperative IMRT without image guidance after radical prostatectomy (RP + IMRT). Patients were matched in a 1:1 ratio according to their baseline risk group before any treatment. Late toxicity was scored using the CTV v3.0 scale. Biochemical failure was defined as a postoperative PSA ≤ 0.1 ng/mL followed by 1 consecutive rising PSA for the postoperative group of patients and by the Phoenix definition (nadir + 2 ng/mL) for the group of patients treated with exclusive radiotherapy.
  
  
  RESULTS
  A total of 98 patients were matched (49:49). From the start of any treatment, the median follow-up was 56.6 months (CI 95% = [49.6-61.2], range [18.2-115.1]). No patient had late gastrointestinal grade ≥ 2 toxicity in the IG-IMRT group vs. 4% in the RP + IMRT group. Forty two percent of the patients in both groups had late grade ≥ 2 genitourinary toxicity. The 5-year FFF rates in the IG-IMRT group and in the RP + IMRT groups were 93.1% [80.0-97.8] and 76.5% [58.3-87.5], respectively (p = 0.031).
  
  
  CONCLUSIONS
  Patients with a localized PCa treated with IG-IMRT had better oncological outcome than patients treated with RP + IMRT. Further improvements in postoperative IMRT using image guidance and dose escalation are urgently needed.
authors.affiliation: Department of Radiation Oncology, Anticancer center Georges François, Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Azelie
authors.forename: Mélanie
authors.initials: M
authors.lastname: Gauthier
authors.forename: Céline
authors.initials: C
authors.lastname: Mirjolet
authors.forename: Luc
authors.initials: L
authors.lastname: Cormier
authors.forename: Etienne
authors.initials: E
authors.lastname: Martin
authors.forename: Karine
authors.initials: K
authors.lastname: Peignaux-Casasnovas
authors.forename: Gilles
authors.initials: G
authors.lastname: Truc
authors.forename: Jérôme
authors.initials: J
authors.lastname: Chamois
authors.forename: Philippe
authors.initials: P
authors.lastname: Maingon
authors.forename: Gilles
authors.initials: G
authors.lastname: Créhange
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D018450:Disease Progression; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome