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01.01.2018 | RADIOTHERAPY

Postoperative radiotherapy for prostate cancer: the sooner the better and potential to reduce toxicity even further

verfasst von: Paolo Borghetti, Luigi Spiazzi, Claudia Cozzaglio, Sara Pedretti, Bruno Caraffini, Luca Triggiani, Diana Greco, Lilia Bardoscia, Fernando Barbera, Michela Buglione, Stefano Maria Magrini

Erschienen in: La radiologia medica | Ausgabe 1/2018

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Abstract

Purpose

To evaluate biochemical relapse-free survival (bRFS), overall survival (OS), late rectal and bladder toxicities in a retrospective single institution series, also applying an in-house software for biological dose calculation.

Methods

258 patients submitted to radiotherapy after prostatectomy were considered. Differences between groups were calculated using the log-rank test and the relevant clinical and therapeutic variables were considered for multivariate analysis. PRODVH is an in-house system able to calculate mean dose-volume histograms (DVHs) of a series of patients, to convert them in biologically effective DVHs (BEDVHs) and allowing to compare them with ANOVA and t Student test.

Results

Adjuvant radiotherapy (ART) and salvage radiotherapy (SRT) were performed in 131 (50.8%) and 127 patients (49.2%). At multivariate analysis advanced T stage, androgen deprivation total (ADT) and SRT resulted as independent variables related to a worst bRFS (p = 0.019, 0.001 and 0.02), while GS > 7 and SRT affected negatively OS (p 0.047 and 0.039). High grade toxicity events occurred mainly in patients treated with 3-dimensional conformal radiotherapy (3DCRT) (proctitis p = 0.006; cystitis: p = 0.041). A significantly more favorable mean rectum BEDVH for patients with G0 or G1 rectal toxicity was shown (p < 0.001). Mean BEDVH for both bladder (p < 0.01) and rectum (p < 0.05) were also significantly better for volumetric modulated arc therapy–image guided radiotherapy (VMAT–IGRT) plans than for 3DCRT plans.

Conclusion

ART is better than SRT in terms of bRFS and OS, particularly for more aggressive cases, advanced T stage and higher Gleason Score. Postoperative prostate cancer radiotherapy should be applied as soon as possible after surgery. The use of modern techniques such as VMAT–IGRT significantly reduces toxicity.

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Titel: Postoperative radiotherapy for prostate cancer: the sooner the better and potential to reduce toxicity even further
verfasst von: Paolo Borghetti
Luigi Spiazzi
Claudia Cozzaglio
Sara Pedretti
Bruno Caraffini
Luca Triggiani
Diana Greco
Lilia Bardoscia
Fernando Barbera
Michela Buglione
Stefano Maria Magrini
Publikationsdatum: 01.01.2018
Verlag: Springer Milan
Erschienen in: La radiologia medica / Ausgabe 1/2018
Print ISSN: 0033-8362
Elektronische ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-017-0807-x

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Postoperative radiotherapy for prostate cancer: the sooner the better and potential to reduce toxicity even further