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Early and late toxicity profiles of patients receiving immediate postoperative radiotherapy versus salvage radiotherapy for prostate cancer after prostatectomy

Früh- und Spättoxizitätsprofile bei Patienten mit unmittelbar postoperativer Radiotherapie vs. Salvage-Radiotherapie bei Prostatakarzinom nach Prostatektomie

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Abstract

Purpose

The present study aims to evaluate both early and late toxicity profiles of patients receiving immediate postoperative radiotherapy (RT; adjuvant RT or additive RT) compared to salvage RT.

Methods

We evaluated 253 patients with prostate cancer treated with either immediate postoperative (adjuvant RT, n = 42; additive RT, n = 39) or salvage RT (n = 137). Thirty-five patients received salvage treatment but did not achieve a postoperative prostate specific antigen (PSA) level <0.1 ng/ml and thus were excluded from analysis.

Results

A significantly higher rate of early grade 1/2 proctitis in the immediate postoperative RT group without additional pelvic RT was observed (p = 0.02). Patients in the immediate postoperative RT group without additional pelvic RT showed significantly more early urinary tract obstructions (p = 0.003). Toxicity rates of early (<3 months) and late (3–6 months) postoperative RT were similar (p > 0.05). Baseline recovery rate of erectile dysfunction was better in patients with immediate postoperative RT without additional pelvic RT (p = 0.02; hazard ratio (HR) = 2.22, 95%-confidence interval, 95%-CI: 1.12–4.37). Recovery rate of urinary incontinence showed no significant difference in all groups (p > 0.05).

Conclusion

Patients receiving immediate postoperative RT (adjuvant or additive RT) without additional pelvic RT experience early gastrointestinal (GI) side effect proctitis and, as well as early genitourinary (GU) toxicity urinary tract obstruction more frequently than patients treated with salvage RT. Therefore, complete recovery after surgery is essential. However, we suggest basing the treatment decision on the patient’s postoperative clinical condition and evaluation of any adverse risk factors, since many studies demonstrate a clear benefit for immediate postoperative RT (adjuvant or additive RT) in terms of oncological outcome.

Zusammenfassung

Hintergrund

In der vorliegenden Auswertung werden die frühen und späten Nebenwirkungen der sofortigen postoperativen Radiotherapie (RT; adjuvante oder additive RT) mit der Salvage-RT verglichen.

Methoden

Die Autoren werteten die Daten von 253 Patienten mit Prostatakarzinom aus, welche mit sofortiger postoperativer RT behandelt wurden: n = 42 für adjuvante RT, n = 39 für additive RT, n = 137 für Salvage-RT. Die 35 mit einer Salvage-Therapie behandelten Patienten, die keinen postoperativen Nadir für das prostataspezifische Antigen (PSA) <0,1 ng/ml erreichten, wurden aus der Analyse ausgeschlossen.

Ergebnisse

Patienten mit sofortiger postoperativer RT ohne zusätzliche RT des Beckens zeigten eine signifikant höhere Rate an frühen Grad-1/2-Proktitiden (p = 0,02). Außerdem wies diese Gruppe signifikant mehr frühe obstruktive Uropathien auf (p = 0,003). Es gab keinen signifikanten Unterschied (p > 0,05) bezüglich der Nebenwirkungsprofile zwischen Patienten mit früher postoperativer RT (innerhalb <3 Monate) vs. späte postoperative RT (innerhalb von 3–6 Monaten). Die Post-RT-Rückbildungsrate der erektilen Dysfunktion war signifikant besser bei Patienten mit sofortiger postoperativer RT ohne zusätzliche RT des Beckens (p = 0,02; Hazard Ratio, HR = 2,22; 95%-Konfidenzintervall, 95%-KI: 1.12–4,37). Dagegen wies die Rückbildungsrate einer Harninkontinenz keine signifikanten Unterschiede in allen Gruppen auf (p > 0,05).

Schlussfolgerung

Bei Patienten mit sofortiger postoperativer RT (adjuvante oder additive RT) ohne zusätzliche RT des Beckens treten häufiger frühe gastrointestinale Nebenwirkungen wie Proktitis auf. Ebenso leiden sie häufiger an obstruktiven Uropathien. Eine komplette postoperative Erholung von Nebenwirkungen ist deswegen wichtig. Die Autoren empfehlen daher, die Therapieentscheidung mit Blick auf den postoperativen Zustand des Patienten und vorhandene Risikofaktoren für ein Rezidiv zu treffen, denn manche Tumorfaktoren machen eine aggressive Vorgehensweise notwendig.

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Authors and Affiliations

  1. Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany

    Marco M. E. Vogel, Kerstin A. Kessel, Jan J. Wilkens &  Stephanie E. Combs

  2. Institute for Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany

    Marco M. E. Vogel, Kerstin A. Kessel &  Stephanie E. Combs

  3. Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany

    Kerstin A. Kessel &  Stephanie E. Combs

  4. Department of Urology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany

    Jürgen E. Gschwend

  5. Department of Pathology, Technical University of Munich (TUM), Munich, Germany

    Wilko Weichert

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  1. Marco M. E. Vogel
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Correspondence to Stephanie E. Combs.

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M.M.E. Vogel, K.A. Kessel, J.E. Gschwend, W. Weichert, J.J. Wilkens and S.E. Combs declare that they have no competing interests.

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The present work is approved by the Ethics Commission of the Technical University of Munich (TUM) and is registered with the project number 320/14.

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Vogel, M.M.E., Kessel, K.A., Gschwend, J.E. et al. Early and late toxicity profiles of patients receiving immediate postoperative radiotherapy versus salvage radiotherapy for prostate cancer after prostatectomy. Strahlenther Onkol 195, 131–144 (2019). https://doi.org/10.1007/s00066-018-1359-2

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