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Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy

A propensity score-matched analysis

Gezielte Becken- versus Salvage-Bestrahlung des Prostatabetts nach radikaler Prostatektomie

Eine ergebnisorientierte Analyse

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Abstract

Purpose

To compare the impact of elective whole pelvic radiotherapy (WPRT) versus prostate bed-only radiotherapy (PBRT) on biochemical relapse-free survival (bRFS) in prostate cancer patients treated with salvage radiotherapy following radical prostatectomy (RP).

Patients and methods

In our database, 163 lymph node-negative prostate cancer patients who had undergone salvage radiotherapy (SRT) for biochemical relapse after RP between September 2004 and April 2012 were identified. PBRT was administered to 134 patients (the PBRT group), while the remaining 29 patients (the WPRT group) received WPRT.

Results

Median follow-up was 57 months (range 18–122 months). In the propensity score-matched cohort, the 4-year bRFS of the WPRT group was significantly higher compared to the PBRT group (63.1 vs. 43.4 %, p = 0.034). Subgroup analysis showed that the bRFS of patients who had two or more risk factors (seminal vesicle invasion, Roach score for lymph node invasion ≥ 45 %, and number of harvested lymph nodes ≤ 5) and were treated with WPRT was significantly improved compared to those who received PBRT (hazard ratio, HR 0.33; 95 % confidence interval, CI 0.13–0.83; p = 0.018).

Conclusion

Elective WPRT for SRT may improve bRFS in patients with unfavorable risk factors. These results need to be confirmed by a prospective randomized trial.

Zusammenfassung

Ziel

Vergleich der Auswirkungen der gezielten Beckenstrahlentherapie (WPRT) gegenüber der Prostatastrahlentherapie (PBRT) hinsichtlich des biochemischen rezidivfreien Überlebens (bRFS) bei Prostatakarzinompatienten, die nach radikaler Prostatektomie (RP) mit einer Salvage-Strahlentherapie (SRT) behandelt wurden.

Patienten und Methoden

Aus unserer Datenbank wurden 163 lymphknotennegative Patienten mit Prostatakrebs identifiziert, die sich nach RP zwischen September 2004 und April 2012 wegen einem biochemischen Rückfall einer rettenden SRT unterzogen hatten. PBRT wurde 134 Patienten verabreicht (PBRT-Gruppe), während die übrigen 29 Patienten eine WPRT erhielten (WPRT-Gruppe).

Ergebnisse

Die mediane Nachbeobachtungszeit betrug 57 Monate (Spanne: 18–122 Monate). In der auf den Propensity-Score abgestimmten Kohorte war das 4-Jahres-bRFS der WPRT-Gruppe im Vergleich zur PBRT-Gruppe signifikant höher (63,1 vs. 43,4 %; p = 0,034). Eine Untergruppenanalyse zeigte, dass sich das bRFS der Patienten, die zwei oder mehr Risikofaktoren hatten (Samenblasenbefall, Roach-Score für Lymphknotenbefall ≥ 45 % und Zahl der entfernten Lymphknoten ≤ 5) und mit WPRT behandelt wurden, im Vergleich zu diejenigen, die PBRT erhalten hatten, deutlich verbessert (Hazard-Ratio 0,33; 95 %-Konfidenzintervall 0,13–0,83; p = 0,018).

Fazit

Eine gezielte WPRT-Strahlentherapie kann das bRFS bei Patienten mit ungünstigen Risikofaktorenverbessern. Diese Ergebnisse müssen in einer prospektiven randomisierten Studie bestätigt werden.

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Authors and Affiliations

  1. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 463–707, Seongnam, Korea/Republic of Korea

    Changhoon Song M.D., Hyun-Cheol Kang M.D., Jae-Sung Kim M.D., Ph.D., Keun-Yong Eom M.D., In Ah Kim M.D., PhD. & Jin-Beom Chung Ph.D.

  2. Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Sung Kyu Hong M.D., Ph.D., Seok-Soo Byun M.D., Ph.D. & Sang Eun Lee M.D., Ph.D.

  3. Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea

    Hyun-Cheol Kang M.D.

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  1. Changhoon Song M.D.
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Correspondence to Jae-Sung Kim M.D., Ph.D..

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Conflict of interest

C. Song, H.-C. Kang, J.-S. Kim,*, K.-Y. Eom, I.A. Kim, J.-B. Chung, S.K. Hong, S.-S. Byun, and S.E. Lee state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Additional information

Changhoon Song and Hyun-Cheol Kang contributed equally to this work.

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Song, C., Kang, HC., Kim, JS. et al. Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy. Strahlenther Onkol 191, 801–809 (2015). https://doi.org/10.1007/s00066-015-0872-9

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  • DOI: https://doi.org/10.1007/s00066-015-0872-9

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