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Adjuvant versus salvage radiotherapy in prostate cancer: multi-institutional retrospective analysis of the Spanish RECAP database

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Abstract

Purpose

To compare adjuvant radiotherapy (ART) to salvage radiotherapy (SRT) after radical prostatectomy (RP) in a cohort of prostate cancer (PCa) patients. The primary aim was to comparatively assess 2- and 5-year biochemical relapse-free survival (BRFS). A secondary aim was to identify predictors of survival.

Patients and methods

Data were acquired from the RECAP database, a population-based prostate cancer registry in Spain. Inclusion criteria included RP (with or without lymphadenectomy) followed by ART or SRT. A total of 702 patients were analyzed. Pre-RT PSA values (>0.5 vs. ≤0.5 ng/ml), pathological stage (T1–2 vs. T3–4), post-surgical Gleason score (≤7 vs. 8–10), margin status (positive vs. negative), hormonal treatment (yes vs. no), and RT dose (≤66 Gy vs. >66 Gy) were evaluated to assess their impact on BRFS.

Results

The mean patient age in the ART and SRT groups, respectively, was 64 years (range 42–82) and 64.8 years (range 42–82). Median follow-up after RT in the whole sample was 34 months (range 3–141). A total of 702 patients were included: 223 (31.8%) received ART and 479 (68.2%) SRT. BRFS rates (95% CI) in the ART and SRT groups at months 24 and 60 were, respectively: 98.1% (95.9–100.0%) vs. 91.2% (88.2–94.2%) and 84.5% (76.4–92.6%) vs. 74.0% (67.4–80.7%) (p = 0.004). No significant differences in OS were observed (p = 0.053). The following variables were significant predictors of biochemical recurrence in the SRT group: (1) positive surgical margin status (p = 0.049); (2) no hormonotherapy (p = 0.03); (3) total prostate dose ≤66 Gy (p = 0.004); and pre-RT PSA ≥0.5 ng/ml (p = 0.013).

Conclusions

This is the first nationwide study in Spain to evaluate a large cohort of PCa patients treated with RP followed by postoperative RT. ART yielded better 2- and 5-year BRFS rates, although OS was equivalent. These findings are consistent with most other published studies and support ART in patients with adverse prognostic characteristics after radical prostatectomy. Prospective trials are needed to compare immediate ART to early SRT to better determine their relative benefits.

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Hospital Ramón Y Cajal, Madrid, Spain

    A. Hervás

  2. Department of Radiation Oncology, Hospital Clínico Universitario, Santiago de Compostela, Spain

    A. Gómez-Caamaño

  3. Department of Radiation Oncology, Instituto Valenciano de Oncologia, Valencia, Spain

    M. Casaña & J. L. Mengual

  4. Department of Radiation Oncology, Hospital Universitario Cruces, Barakaldo, Spain

    A. Gómez-Iturriaga

  5. Department of Radiation Oncology, Hospital General de Valencia, Valencia, Spain

    J. Pastor

  6. Department of Radiation Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain

    J. Jove

  7. Department of Radiation Oncology, Hospital Gregorio Marañón, Madrid, Spain

    C. Gónzalez-San Segundo

  8. Department of Radiation Oncology, Hospital Infanta Cristina, Badajoz, Spain

    J. Muñoz

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  1. A. Hervás
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  2. A. Gómez-Caamaño
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  3. M. Casaña
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  4. A. Gómez-Iturriaga
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  5. J. Pastor
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  7. J. L. Mengual
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  8. C. Gónzalez-San Segundo
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Correspondence to A. Hervás.

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The authors state that they have no relation-ships, conditions or circumstances that present potential conflicts of interest with this study.

Ethical approval

The retrospective review of medical records was approved by the local ethics committees.

Informed consent

Informed consent was obtained from all live individual participants included in the study.

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Hervás, A., Gómez-Caamaño, A., Casaña, M. et al. Adjuvant versus salvage radiotherapy in prostate cancer: multi-institutional retrospective analysis of the Spanish RECAP database. Clin Transl Oncol 20, 193–200 (2018). https://doi.org/10.1007/s12094-017-1709-z

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  • DOI: https://doi.org/10.1007/s12094-017-1709-z

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