title: Image Guided Hypofractionated Postprostatectomy Intensity Modulated Radiation Therapy for Prostate Cancer.
abstract: OBJECTIVE
  Hypofractionated radiation therapy (RT) has promising long-term biochemical relapse-free survival (bRFS) with comparable toxicity for definitive treatment of prostate cancer. However, data reporting outcomes after adjuvant and salvage postprostatectomy hypofractionated RT are sparse. Therefore, we report the toxicity and clinical outcomes after postprostatectomy hypofractionated RT.
  
  
  METHODS
  From a prospectively maintained database, men receiving image guided hypofractionated intensity modulated RT (HIMRT) with 2.5-Gy fractions constituted our study population. Androgen deprivation therapy was used at the discretion of the radiation oncologist. Acute toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Biochemical recurrence was defined as an increase of 0.1 in prostate-specific antigen (PSA) from posttreatment nadir or an increase in PSA despite treatment. The Kaplan-Meier method was used for the time-to-event outcomes.
  
  
  RESULTS
  Between April 2008 and April 2012, 56 men received postoperative HIMRT. The median follow-up time was 48 months (range, 21-67 months). Thirty percent had pre-RT PSA <0.1; the median pre-RT detectable PSA was 0.32 ng/mL. The median RT dose was 65 Gy (range, 57.5-65 Gy). Ten patients received neoadjuvant and concurrent hormone therapy. Posttreatment acute urinary toxicity was limited. There was no acute grade 3 toxicity. Late genitourinary (GU) toxicity of any grade was noted in 52% of patients, 40% of whom had pre-RT urinary incontinence. The 4-year actuarial rate of late grade 3 GU toxicity (exclusively gross hematuria) was 28% (95% confidence interval [CI], 16%-41%). Most grade 3 GU toxicity resolved; only 7% had persistent grade ≥3 toxicity at the last follow-up visit. Fourteen patients experienced biochemical recurrence at a median of 20 months after radiation. The 4-year bPFS rate was 75% (95% CI, 63%-87%).
  
  
  CONCLUSIONS
  The biochemical control in this series appears promising, although relatively short follow-up may lead to overestimation. Late grade 3 GU toxicity was higher than anticipated with hypofractionated radiation of 65 Gy to the prostate bed, although most resolved.
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors: Stephen L
authors: SL
authors: Lewis
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors: Pretesh
authors: P
authors: Patel
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors: Haijun
authors: H
authors: Song
authors: Surgery Section, Durham Veterans Administration, and Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Stephen J
authors: SJ
authors: Freedland
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors: Sigrun
authors: S
authors: Bynum
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors: Daniel
authors: D
authors: Oh
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors: Manisha
authors: M
authors: Palta
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors: David
authors: D
authors: Yoo
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors: James
authors: J
authors: Oleson
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina. Electronic address: joseph.salama@duke.edu.
authors: Joseph K
authors: JK
authors: Salama
mesh_terms: D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D000069473:Radiation Dose Hypofractionation; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen