Long-term results of adjuvant versus early salvage post-prostatectomy radiation: a large single institutional experience

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Daniela L. Buscariollo, Michael Drumm, Andrzej Niemierko, Rebecca H. Clayman, Sigolene Galland-Girodet, Danielle Rodin, Adam S. Feldman, Douglas Dahl, Francis J. McGovern, Aria Olumi, Alec Eidelman, William U. Shipley, Anthony L. Zietman, Jason A. Efstathiou
PurposeTo evaluate freedom from biochemical failure (FFBF), freedom from androgen deprivation therapy (FFADT), freedom from distant metastases (FFDM), and overall survival (OS) after adjuvant radiation therapy (ART) versus early salvage radiation therapy (ESRT) in men with prostate cancer and adverse pathologic features (pT3 and/or positive surgical margins).Methods and MaterialsOf 718 patients consecutively treated with postoperative radiation therapy (RT) for prostate cancer between 1992 and 2013, we retrospectively identified 171 men receiving ART and 230 receiving ESRT (RT delivered at PSA ≤0.5ng/ml) who had adverse pathologic features. Post-irradiation FFBF (BF was defined as PSA rise to ≥0.2ng/ml), FFADT, FFDM, and OS were compared using Kaplan–Meier and Cox regression methods. Propensity score (PS)-matching was performed to estimate treatment effects while accounting for covariates predicting treatment allocation.ResultsMedian follow-up was 7.4 and 8.0years for patients treated with ART and ESRT, respectively. Ten-year FFBF (69% versus 56%, p=0.003) and 10-year FFADT (88% versus 81%, p=0.046) rates were higher after ART; however, FFDM and OS did not significantly differ. After PS-matching, ART was associated with improved FFBF (p<0.0001), FFADT (p=0.0001), and FFDM (p=0.02). Findings were confirmed in multivariable analyses in unmatched and PS-matched cohorts.ConclusionPostoperative RT confers excellent long-term cancer control. These results suggest ART may be associated with improved FFBF, FFADT, and FFDM, but comparable OS. Given the retrospective study design, these findings should be interpreted with caution. Optimal timing of postoperative RT further awaits results of ongoing trials.



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