title: Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy.
abstract: The aim of this study was to investigate the role of 70 Gy salvage radiotherapy (SRT) combined with short-term neoadjuvant hormonal therapy (NHT) in the treatment of recurrent disease after radical prostatectomy (RP), and to consider quality of life (QoL), survival outcomes and impact of co-morbidities on treatment-related rectal-genitourinary toxicity. Electronic records of 184 SRT patients treated consecutively between October 2001 and February 2007 were analyzed. Median age was 64 years (median follow-up 48 months). NHT was given to 165 patients (median 3 months). Pre-RP and pre-SRT PSA, PSA doubling time, Gleason score (GS), seminal vesicle invasion (SVI) and detectable post-SRT PSA were recorded. Any detectable PSA or PSA >0.1 ng/ml + nadir was considered biochemical failure (BcF). The Charlson co-morbidity index was used to correlate co-morbidities and rectal-genitourinary toxicity. Scores from the health-related QoL EORTC QLQ-C30 and PR-25 questionnaires were also evaluated. In 116 (63%) patients, a long-lasting curative effect was indicated by undetectable PSA levels. In univariate analysis, using BcF as an outcome variable, p<0.001 was found for GS, pre-SRT PSA, SVI and detectable post-SRT PSA. Multivariate analysis showed p=0.01 for SVI, p=0.09 for GS, and detectable post-SRT PSA (p=0.01); with metastases as an outcome variable, only SVI was significant (p=0.007). Cancer-specific and overall survival were 99 and 95%, respectively. Although microscopy showed SVI or GS 8-10 in the prostatectomy specimens 17/40 (43%) and 13/29 (45%), respectively, of patients still showed undetectable PSA at long-term follow-up (median 55 months) after SRT. Likewise, 11/31 (36%) patients with pre-SRT PSA >1.0 ng/ml and 80/134 (60%) patients with PSA doubling time (PSADT) <10 still showed undetectable PSA after 50 months. Slightly elevated acute and late rectal-genitourinary grade 3-4 toxicity was observed. No association with co-morbidity/toxicity was found. EORTC QLQ-C30 scores were similar to or slightly better than reference values. SRT with 70 Gy combined with 3-month NHT results in long-term undetectable PSA in >50% of patients with recurrence after RP with acceptable rectal-genitourinary toxicity and without negatively affecting long-term QoL. Non-metastatic patients should not be disqualified from receiving SRT although presenting with poor prognostic factors at surgery.
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. jeff.cortes-gonzalez@ki.se
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Cortés-González
authors.forename: Enrique
authors.initials: E
authors.lastname: Castellanos
authors.forename: Katinka
authors.initials: K
authors.lastname: Sandberg
authors.forename: Marie-Hjelm
authors.initials: MH
authors.lastname: Eriksson
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.forename: Gabriella
authors.initials: G
authors.lastname: Cohn-Cedermark
authors.forename: Ulrika
authors.initials: U
authors.lastname: Harmenberg
authors.forename: Ove
authors.initials: O
authors.lastname: Gustafsson
authors.forename: Seymour H
authors.initials: SH
authors.lastname: Levitt
authors.forename: Bo
authors.initials: B
authors.lastname: Lennernäs
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Brandberg
authors.forename: Marcela
authors.initials: M
authors.lastname: Márquez
authors.forename: Karl-Mikael
authors.initials: KM
authors.lastname: Kälkner
authors.forename: Sten
authors.initials: S
authors.lastname: Nilsson
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D015996:Survival Rate
chemical_list: D018931:Antineoplastic Agents, Hormonal