title: Long-term tolerance and outcomes for dose escalation in early salvage post-prostatectomy radiation therapy.
abstract: OBJECTIVE
  To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting.
  
  
  METHODS
  The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes.
  
  
  RESULTS
  The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%).
  
  
  CONCLUSIONS
  In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.
authors.affiliation: Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Safdieh
authors.affiliation: Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Weiner
authors.affiliation: Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Weiss
authors.affiliation: University of Florida Health Cancer Center, Orlando, FL, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Rineer
authors.affiliation: Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Isaac
authors.initials: I
authors.lastname: Madeb
authors.affiliation: Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Marvin
authors.initials: M
authors.lastname: Rotman
authors.affiliation: Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
keywords: Dose escalation; Prostate cancer; Radiation therapy; Salvage