title: Adjuvant Radiotherapy Versus Wait-and-See Strategy for Pathologic T3 or Margin-Positive Prostate Cancer: A Meta-Analysis.
abstract: To conduct a meta-analysis of the randomized controlled trials (RCTs) comparing adjuvant radiotherapy (ART) to wait-and-see (WS) strategy in pathologic T3 or margin-positive prostate cancer.
  
  
  
  A comprehensive EMBASE, MEDLINE, http://www.clinicaltrails.gov, and Cochrane Library search for RCTs of ART versus WS was done. Results were synthesized for metastasis-free, biochemical progression-free, clinical progression-free, hormone-free, and overall survival as well as gastrointestinal (GI) and genitourinary (GU) toxicities. Either random-effects model or fixed-effects model were used based on the test of heterogeneity.
  
  
  
  Three RCTs (EORTC22911, SWOG8794, ARO96-02/AUO-AP09/95) were identified with 1737 patients. ART resulted in greater biochemical progression-free survival (hazard ratio [HR]=0.48, P<0.00001) including benefit in all subsets, greater clinical progression-free survival (HR=0.73, P=0.0003) including benefit in subsets with margin-positive or seminal vesicle invasion and, greater hormone-free survival (HR=0.64, 95% confidence interval, 0.51-0.80, P=0.0001). Ten-year metastasis-free survival was significantly improved with ART (odds ratio=0.77, P=0.02). There was no survival benefit (HR=0.97; P=0.89). With ART compared with WS, there was significantly increased toxicity of any grade (50% vs. 38.6%), grade 2 or greater GU toxicity (17.1% vs. 10.3%), grade 2 or greater GI toxicity (2.5% vs. 1.1%), urinary stricture rates (11.1% vs. 5.7%) and, urinary incontinence (6.9% vs. 2.7%).
  
  
  
  Ten-year metastasis-free survival is significantly improved with ART compared with WS. Biochemical progression-free, clinical progression-free, and hormone-free survival were also improved with ART. Grade 2 or higher GI and GU toxicities were greater in ART. Therefore, ART should be offered to patients with these high-risk features.
authors.affiliation: Department of Radiation Oncology, Stritch School of Medicine.
authors.forename: M Parvez
authors.initials: MP
authors.lastname: Shaikh
authors.affiliation: Department of Radiation Oncology, Stritch School of Medicine.
authors.forename: Fiori
authors.initials: F
authors.lastname: Alite
authors.affiliation: Research Methodology, School of Education, Loyola University-Chicago, Chicago, IL.
authors.forename: Meng-Jia
authors.initials: MJ
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Stritch School of Medicine.
authors.forename: Abhishek A
authors.initials: AA
authors.lastname: Solanki
authors.affiliation: Department of Radiation Oncology, Stritch School of Medicine.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Harkenrider
mesh_terms: D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D018714:Radiotherapy, Adjuvant / Q000401:mortality*; D015996:Survival Rate; D057832:Watchful Waiting