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

• A. Hervás ^[1] ; A. Gómez-Caamaño ^[2] ; M. Casaña ^[3] ; A. Gómez-Iturriaga ^[4] ; J. Pastor ^[5] ; J. Jove ^[7] ; J. L. Mengual ^[3] ; C. Gónzalez-San Segundo ^[6] ; J. Muñoz ^[8]
  1. [1] Hospital Ramón y Cajal

     Hospital Ramón y Cajal

     Madrid, España

     
  2. [2] Complexo Hospitalario Universitario de Santiago

     Complexo Hospitalario Universitario de Santiago

     Santiago de Compostela, España

     
  3. [3] Instituto Valenciano de Oncologia

     Instituto Valenciano de Oncologia

     Valencia, España

     
  4. [4] Instituto de Investigación Sanitaria Biocruces Bizkaia

     Instituto de Investigación Sanitaria Biocruces Bizkaia

     Barakaldo, España

     
  5. [5] Hospital General Universitario de Valencia

     Hospital General Universitario de Valencia

     Valencia, España

     
  6. [6] Hospital General Universitario Gregorio Marañón

     Hospital General Universitario Gregorio Marañón

     Madrid, España

     
  7. [7] Hospital Germans Trias i Pujol, España
  8. [8] Hospital Infanta Cristina, Badajoz, España

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 20, Nº. 2 (February 2018), 2018, págs. 193-200
• Idioma: inglés
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• Resumen

  • 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.