title: Adjuvant and salvage radiotherapy after prostatectomy: outcome analysis of 307 patients with prostate cancer.
abstract: OBJECTIVE
  In men with adverse pathology after radical prostatectomy, the most appropriate timing to administer radiotherapy (RT) remains a topic of debate. We analyzed in terms of efficacy, prognostic factors and toxicity the two therapeutic strategies: immediate postoperative radiotherapy (PORT) and salvage radiotherapy (SART).
  
  
  METHODS
  Between January 1995 and November 2010, 307 patients underwent adjuvant or salvage radiotherapy, after prostatectomy.
  
  
  RESULTS
  In the PORT group, 42 patients (20.7 %) had biochemical failure, with a median time to biochemical failure of 1.8 years; two parameters (age at diagnosis and PSA pre-RT) resulted to be significant at the survival analysis for overall survival (p = 0.003 and p = 0.046, respectively). In the SART group, 33 patients (31.7 %) had biochemical relapse; sixteen patients died of prostate cancer; postoperative hormones therapy, conformal radiotherapy and level of PSA pre-RT >1.0 ng/ml resulted to be significant at the survival analysis, p = 0.009, p = 0.039 and p = 0.002, respectively.
  
  
  CONCLUSIONS
  Our study is limited by its retrospective and nonrandomized design. As such, decisions to treat with adjuvant or salvage radiotherapy and the time to initiate therapy were based on patient preference and physician counseling. Our recommendation is to suggest adjuvant radiotherapy for all patients with adverse prognostic factors and to reserve salvage radiotherapy for low-risk patients, when the biochemical recurrence occurs.
authors.affiliation: Radioterapia, Azienda Ospedaliero-Universitaria di Careggi, Viale Morgagni 85, 50144 Florence, Italy. beatrice.detti@unifi.it
authors.forename: Beatrice
authors.initials: B
authors.lastname: Detti
authors.forename: Silvia
authors.initials: S
authors.lastname: Scoccianti
authors.forename: Sara
authors.initials: S
authors.lastname: Cassani
authors.forename: Samantha
authors.initials: S
authors.lastname: Cipressi
authors.forename: Donata
authors.initials: D
authors.lastname: Villari
authors.forename: Alberto
authors.initials: A
authors.lastname: Lapini
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.forename: Tommaso
authors.initials: T
authors.lastname: Cai
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pertici
authors.forename: Irene
authors.initials: I
authors.lastname: Giacomelli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
authors.forename: Marco
authors.initials: M
authors.lastname: Ceroti
authors.forename: Giulio
authors.initials: G
authors.lastname: Nicita
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Biti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000276:immunology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen