title: Adjuvant and salvage radiotherapy after prostatectomy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  In men with adverse prognostic factors (APFs) after radical prostatectomy (RP), the most appropriate timing to administer radiotherapy remains a subject for debate. We conducted a systemic review and meta-analysis to evaluate the therapeutic strategies: adjuvant radiotherapy (ART) and salvage radiotherapy (SRT).
  
  
  METHODS
  We comprehensively searched PubMed, EMBASE, Web of Science and the Cochrane Library and performed the meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the prognostic factors of ART and SRT.
  
  
  RESULTS
  Between May 1998 and July 2012, 2 matched control studies and 16 retrospective studies including a total of 2629 cases were identified (1404 cases for ART and 1185 cases for SRT). 5-year biochemical failure free survival (BFFS) for ART was longer than that for SRT (Hazard Ratio [HR]: 0.37; 95% CI, 0.30-0.46; p<0.00001, I(2) = 0%). 3-year BFFS was significantly longer in the ART (HR: 0.38; 95% CI, 0.28-0.52; p<0.00001, I(2) = 0%). Overall survival (OS) was also better in the ART (RR: 0.53; 95% CI, 0.41-0.68; p<0.00001, I(2) = 0%), as did disease free survival (DFS) (RR: 0.53; 95% CI, 0.43-0.66; p<0.00001, I(2)  = 0%). Exploratory subgroup analysis and sensitivity analysis revealed the similar results with original analysis.
  
  
  CONCLUSIONS
  ART therapy offers a safe and efficient alternative to SRT with longer 3-year and 5-year BFFS, better OS and DFS. Our recommendation is to suggest ART for patients with APFs and may reduce the need for SRT. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update this analysis.
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Changhao
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Tianxin
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Oncology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Doudou
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Kewei
authors.initials: K
authors.lastname: Xu
authors.affiliation: Department of Oncology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Xinxiang
authors.initials: X
authors.lastname: Fan
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Guangzheng
authors.initials: G
authors.lastname: Zhong
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Wang
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xianyin
authors.initials: X
authors.lastname: He
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Huang
mesh_terms: D016022:Case-Control Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy