Title: Salvage Radiation Therapy After Postprostatectomy Failure: Benefits of Hormonal Therapy and Pelvic Nodal Radiation Are Not Necessarily Limited to “High-Risk” Cases
Abstract: Purpose/Objective(s)Salvage radiation therapy (RT) is often given post-prostatectomy. A common perception is that intensification of therapy with concurrent hormonal therapy (ADT) or pelvic nodal RT (WPRT) is most likely to benefit men with more aggressive features (e.g., Gleason 8, pre-RT PSA >0.5). We sought to explore whether WPRT and ADT were associated with improved biochemical control, and whether the benefit was restricted to certain higher-risk subsets.Materials/MethodsOne hundred forty-four men were treated with salvage RT for a detectable PSA post-prostatectomy with no sign of clinical recurrence. Median pre-RT PSA was 0.3 (range, 0.1-2.0). 63% had pT3 disease, 4% had N1 disease, 15% had Gleason 8 disease, 57% had positive margins, and 49% had a persistently positive PSA after surgery. The median RT dose was 66 Gy. WPRT was given in 41 (29%), and ADT in 44 (31%, median 4 months). 30 men (21%) were treated with both WPRT/ADT. Freedom from biochemical failure (FFBF) was defined as lack of PSA >0.1 with a subsequent rise. Univariate (UVA) and multivariable (MVA) analyses were performed testing covariates for associations with FFBF. Median follow-up was 47 months.ResultsOverall, FFBF-4 years was 64%. The use of WPRT and ADT were highly correlated; 70% of men on ADT received WPRT, compared to 11% not on ADT (p < 0.01). On UVA, GS6, positive margins, WPRT (81% vs 57%, p = 0.01), ADT use (83 vs 55%, p < 0.01), and combined WPRT/ADT (86 vs 58%, p = 0.01) were associated with improved FFBF-4 years, while pre-RT PSA ≤0.5 (p = 0.20), IMRT use (p = 0.46), and pT3 stage (p = 0.46). On MVA UVA factors with p < 0.05 and pre-RT PSA, all factors were associated with outcome (table). In exploratory subset UVAs, combined WPRT/ADT was associated with FFBF in men with PSA ≤0.5 (p < 0.01), but not PSA >0.5 (p = 0.73). WPRT was associated with FFBF in men with GS 7 (p = 0.01) and a trended to association in men with GS 8 (p = 0.19). MVAs grouped by PSA and GS supported the UVA findings, as WPRT/ADT remained associated with FFBF when controlling for other covariates in the subsets of men with PSA ≤0.5 and Gleason score ≤7.ConclusionsPoster Viewing Abstract 2488; TableMultivariable analysis for freedom from biochemical failureRisk ratio (95% CI)P valuePathologic Gleason score ≥7 (yes/no)3.61 (1.69-8.96)<.01Positive margins (yes/no)0.43 (0.24-0.76)<.01Whole pelvic radiation therapy (yes/no)0.48 (0.21-1.00).05Androgen deprivation therapy (yes/no)0.47 (0.22-0.93).03Pre-RT PSA (continuous)2.14 (1.10-4.01).03 Open table in a new tab Purpose/Objective(s)Salvage radiation therapy (RT) is often given post-prostatectomy. A common perception is that intensification of therapy with concurrent hormonal therapy (ADT) or pelvic nodal RT (WPRT) is most likely to benefit men with more aggressive features (e.g., Gleason 8, pre-RT PSA >0.5). We sought to explore whether WPRT and ADT were associated with improved biochemical control, and whether the benefit was restricted to certain higher-risk subsets. Salvage radiation therapy (RT) is often given post-prostatectomy. A common perception is that intensification of therapy with concurrent hormonal therapy (ADT) or pelvic nodal RT (WPRT) is most likely to benefit men with more aggressive features (e.g., Gleason 8, pre-RT PSA >0.5). We sought to explore whether WPRT and ADT were associated with improved biochemical control, and whether the benefit was restricted to certain higher-risk subsets. Materials/MethodsOne hundred forty-four men were treated with salvage RT for a detectable PSA post-prostatectomy with no sign of clinical recurrence. Median pre-RT PSA was 0.3 (range, 0.1-2.0). 63% had pT3 disease, 4% had N1 disease, 15% had Gleason 8 disease, 57% had positive margins, and 49% had a persistently positive PSA after surgery. The median RT dose was 66 Gy. WPRT was given in 41 (29%), and ADT in 44 (31%, median 4 months). 30 men (21%) were treated with both WPRT/ADT. Freedom from biochemical failure (FFBF) was defined as lack of PSA >0.1 with a subsequent rise. Univariate (UVA) and multivariable (MVA) analyses were performed testing covariates for associations with FFBF. Median follow-up was 47 months. One hundred forty-four men were treated with salvage RT for a detectable PSA post-prostatectomy with no sign of clinical recurrence. Median pre-RT PSA was 0.3 (range, 0.1-2.0). 63% had pT3 disease, 4% had N1 disease, 15% had Gleason 8 disease, 57% had positive margins, and 49% had a persistently positive PSA after surgery. The median RT dose was 66 Gy. WPRT was given in 41 (29%), and ADT in 44 (31%, median 4 months). 30 men (21%) were treated with both WPRT/ADT. Freedom from biochemical failure (FFBF) was defined as lack of PSA >0.1 with a subsequent rise. Univariate (UVA) and multivariable (MVA) analyses were performed testing covariates for associations with FFBF. Median follow-up was 47 months. ResultsOverall, FFBF-4 years was 64%. The use of WPRT and ADT were highly correlated; 70% of men on ADT received WPRT, compared to 11% not on ADT (p < 0.01). On UVA, GS6, positive margins, WPRT (81% vs 57%, p = 0.01), ADT use (83 vs 55%, p < 0.01), and combined WPRT/ADT (86 vs 58%, p = 0.01) were associated with improved FFBF-4 years, while pre-RT PSA ≤0.5 (p = 0.20), IMRT use (p = 0.46), and pT3 stage (p = 0.46). On MVA UVA factors with p < 0.05 and pre-RT PSA, all factors were associated with outcome (table). In exploratory subset UVAs, combined WPRT/ADT was associated with FFBF in men with PSA ≤0.5 (p < 0.01), but not PSA >0.5 (p = 0.73). WPRT was associated with FFBF in men with GS 7 (p = 0.01) and a trended to association in men with GS 8 (p = 0.19). MVAs grouped by PSA and GS supported the UVA findings, as WPRT/ADT remained associated with FFBF when controlling for other covariates in the subsets of men with PSA ≤0.5 and Gleason score ≤7. Overall, FFBF-4 years was 64%. The use of WPRT and ADT were highly correlated; 70% of men on ADT received WPRT, compared to 11% not on ADT (p < 0.01). On UVA, GS6, positive margins, WPRT (81% vs 57%, p = 0.01), ADT use (83 vs 55%, p < 0.01), and combined WPRT/ADT (86 vs 58%, p = 0.01) were associated with improved FFBF-4 years, while pre-RT PSA ≤0.5 (p = 0.20), IMRT use (p = 0.46), and pT3 stage (p = 0.46). On MVA UVA factors with p < 0.05 and pre-RT PSA, all factors were associated with outcome (table). In exploratory subset UVAs, combined WPRT/ADT was associated with FFBF in men with PSA ≤0.5 (p < 0.01), but not PSA >0.5 (p = 0.73). WPRT was associated with FFBF in men with GS 7 (p = 0.01) and a trended to association in men with GS 8 (p = 0.19). MVAs grouped by PSA and GS supported the UVA findings, as WPRT/ADT remained associated with FFBF when controlling for other covariates in the subsets of men with PSA ≤0.5 and Gleason score ≤7. ConclusionsPoster Viewing Abstract 2488; TableMultivariable analysis for freedom from biochemical failureRisk ratio (95% CI)P valuePathologic Gleason score ≥7 (yes/no)3.61 (1.69-8.96)<.01Positive margins (yes/no)0.43 (0.24-0.76)<.01Whole pelvic radiation therapy (yes/no)0.48 (0.21-1.00).05Androgen deprivation therapy (yes/no)0.47 (0.22-0.93).03Pre-RT PSA (continuous)2.14 (1.10-4.01).03 Open table in a new tab
Publication Year: 2013
Publication Date: 2013-09-20
Language: en
Type: article
Indexed In: ['crossref']
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