Image-guided, whole-pelvic, intensity-modulated radiotherapy for biochemical recurrence following radical prostatectomy in high-risk prostate cancer patients

The optimal field size of salvage radiotherapy (SRT) for biochemical recurrence, particularly for patients with high-risk prostate cancer, remains undefined. This retrospective analysis was performed to investigate oncological outcomes as well as treatment-related toxicity following salvage intensit...

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Bibliographic Details
Published in:PloS one 2018-01, Vol.13 (1), p.e0190479
Main Authors: Byun, Sang Jun, Kim, Young Seok, Ahn, Hanjong, Kim, Choung-Soo
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Antigens
Balloon treatment
Biochemistry
Biology and Life Sciences
Cancer
Cancer patients
Cancer surgery
Cancer therapies
Care and treatment
Clinical trials
Computed tomography
Deprivation
Diagnosis
Dosimetry
Drug dosages
Health aspects
Health risks
Humans
Male
Medical imaging
Medical prognosis
Medical records
Medicine
Medicine and Health Sciences
Middle Aged
Multivariate analysis
Neoplasm Recurrence, Local
Oncology
Patients
Pelvis
Pelvis - pathology
Planning
Prostate cancer
Prostate-specific antigen
Prostatectomy
Prostatectomy - methods
Prostatic Neoplasms - pathology
Prostatic Neoplasms - radiotherapy
Radiation therapy
Radiotherapy
Radiotherapy, Intensity-Modulated - methods
Risk
Risk factors
Salvage
Survival
Toxicity
Urological surgery
Urology
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Summary:The optimal field size of salvage radiotherapy (SRT) for biochemical recurrence, particularly for patients with high-risk prostate cancer, remains undefined. This retrospective analysis was performed to investigate oncological outcomes as well as treatment-related toxicity following salvage intensity-modulated radiotherapy (IMRT) to the whole pelvis and to compare the results with other studies implementing a small field size of the prostate bed. The medical records of 170 patients with high-risk prostate cancer who received SRT for biochemical recurrence following prostatectomy were reviewed. Whole-pelvic IMRT was administered with a median dose of 66 Gy in 30 fractions. To improve treatment accuracy, an endorectal balloon device and daily cone-beam computed tomography were utilized. Androgen-deprivation therapy combined with SRT was administered to 97 (57.1%) patients. Eventually, 68 (40.0%) patients showed biochemical progression (BCP) after SRT. With a median follow-up period of 56 months, the 5-year BCP-free survival was 38.6%. The overall and cause-specific survival rates were 90.9% and 96.7%, respectively. Regarding BCP-free survival analysis, pathological T stage, persistent prostate-specific antigen (PSA) elevation after prostatectomy, and preSRT PSA level were significant prognostic factors on univariate analysis. On multivariate analysis, pathological T stage and preSRT PSA value retained their significance. Acute and late grade-3 genitourinary toxicities were observed in one (0.6%) and five (2.9%) patients, respectively. One patient each developed acute and late grade-3 gastrointestinal toxicity. SRT to whole pelvis using IMRT and image guidance is as safe as SRT to the prostate bed, but its efficacy should be confirmed in ongoing randomized trials. PreSRT PSA was the only controllable prognostic factor, suggesting the benefit of early SRT.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0190479