Salvage Radiotherapy for Prostate-Specific Antigen Relapse after Radical Prostatectomy for Prostate Cancer: Experience at the Instituto Nacional de Cancerología
Keywords:
Prostatic neoplasms, brachytherapy, prostatectomy, prostate-specific antigenAbstract
Objective: To describe a National Cancer Institute (NCI) study on rescue radiotherapy carried out among patients who had biochemical relapse following radical prostatectomy.
Methods: A retrospective, observational study was performed on cases treated from 2003 to 2007; descriptive statistics, using relative frequency as well as measures of central tendency and dispersion, were used to analyze information. Disease free survival was described.
Results: A total of 40 patients who underwent rescue radiotherapy for biochemical relapse were included in the study. Post-prostatectomy relapse occurred within 2 years in 65% of patients. Median pre-radiotherapy PSA was 0.9ng/ml. 3D conformational radiotherapy was used to treat 87.5% of cases; 97.5% of patients received a total dose of 66 Gy. In accordance with disease risk classification, disease free survival was 2.29 years, with 28.5 months median follow-up. Two patients had biochemical relapse following rescue radiotherapy.
Conclusions: Rescue radiotherapy has been shown to be an appropriate intervention for prostate cancer patients with biochemical relapse following radical prostatectomy; 94% of patients treated with rescue radiotherapy at the NCI from 2003 to 2007 are relapse free.
Author Biographies
Rosalba Ospino, Instituto Nacional de Cancerología
Grupo de Radioterapia, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia
Juan Galvis, Instituto Nacional de Cancerología
Grupo de Radioterapia, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia
Jorge Rugeles, Instituto Nacional de Cancerología
Grupo de Radioterapia, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia
Angélica Mojica, Instituto Nacional de Cancerología
Grupo de Radioterapia, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia
José Esguerra, Instituto Nacional de Cancerología
Grupo de Radioterapia, Instituto Nacional de Cancerología, Bogotá, D. C., Colombia
References
Penson DF, Chan JM. Prostate cancer. J Urol. 2007;177:2020-9.
https://doi.org/10.1016/j.juro.2007.01.121
Forman JD, Meetze K, Pontes E, et al. Therapeutic irradiation for patients with an elevated post-prostatectomy prostate specific antigen level. J Urol. 1997;158:1436-9.
https://doi.org/10.1016/S0022-5347(01)64235-6
Lowes LE, Lock M, Rodríguez G, et al. Circulating tumour cells in prostate cancer patients receiving salvage radiotherapy. Clin Transl Oncol. 2012;14:150-6.
https://doi.org/10.1007/s12094-012-0775-5
Han M, Partin AW, Pound CR, et al. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am. 2001;28:555-65.
https://doi.org/10.1016/S0094-0143(05)70163-4
Ward JF, Moul JW. Rising prostate-specific antigen after primary prostate cancer therapy. Nat Clin Pract Urol. 2005;2:174-82.
https://doi.org/10.1038/ncpuro0145
Pound CR, Partin AW, Eisenberger MA, et al. Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 1999;281:1591-7.
https://doi.org/10.1001/jama.281.17.1591
Sia M, Pickles T, Morton G, et al. Salvage radiotherapy following biochemical relapse after radical prostatectomy: proceedings of the Genito-Urinary Radiation Oncologists of Canada consensus meeting. Can Urol Assoc J. 2008;2:500-7.
https://doi.org/10.5489/cuaj.916
D'Amico AV, Moul JW, Carroll PR, et al. Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst. 2003;95:1376-83.
https://doi.org/10.1093/jnci/djg043
Roberts SG, Blute ML, Bergstralh EJ, et al. PSA doubling time as a predictor of clinical progression after biochemical failure following radical prostatectomy for prostate cancer. Mayo Clin Proc. 2001;76:576-81.
https://doi.org/10.1016/S0025-6196(11)62406-3
Shekarriz B, Upadhyay J, Wood DP, Jr., et al. Vesicourethral anastomosis biopsy after radical prostatectomy: predictive value of prostate-specific antigen and pathologic stage. Urology. 1999;54:1044-8.
https://doi.org/10.1016/S0090-4295(99)00351-9
Bolla M, van PH, Collette L, et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet. 2005;366:572-8.
https://doi.org/10.1016/S0140-6736(05)67101-2
Thompson IM, Jr., Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA. 2006;296:2329-35.
https://doi.org/10.1001/jama.296.19.2329
Wiegel T, Störkel S, Bottke D, et al. Prostate cancer: Phase III study of adjuvant radiotherapy versus wait and see: Impact of pathologic review on analysis. JCO. 2009;27:2924-30.
https://doi.org/10.1200/JCO.2008.18.9563
Choo R, Kawakami J, Siemens R, et al. Two different perspectives in the management of pT3 and/or marginpositive prostate cancer after radical prostatectomy. BJU Int. 2006;98:773-6.
https://doi.org/10.1111/j.1464-410X.2006.06423.x
Boccon, L. pT3 prostate cancer: the case for salvage (as opposed to adjuvant) radiation therapy. Eur Urol Supp. 2007;6:511-72.
https://doi.org/10.1016/j.eursup.2007.01.026
Catton C, Gospodarowicz M, Warde P, et al. Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol. 2001;59:51-60.
https://doi.org/10.1016/S0167-8140(01)00302-4
Neuhof D, Hentschel T, Bischof M, et al. Long-term results and predictive factors of three-dimensional conformal salvage radiotherapy for biochemical relapse after prostatectomy. Int J Radiat Oncol Biol Phys. 2007;67:1411-7.
https://doi.org/10.1016/j.ijrobp.2006.11.024
Stephenson AJ, Shariat SF, Zelefsky MJ, et al. Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA. 2004;291:1325-32.
https://doi.org/10.1001/jama.291.11.1325
Stephenson AJ, Scardino PT, Kattan MW, et al. Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol. 2007;25:2035-41.
https://doi.org/10.1200/JCO.2006.08.9607
Trock BJ, Han M, Freedland SJ, et al. Prostate cancerspecific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA. 2008;299:2760-9.
https://doi.org/10.1001/jama.299.23.2760
Michalski J, Lawton C, El Naqa I, et al. Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;76:361-8.
https://doi.org/10.1016/j.ijrobp.2009.02.006
Moreira DM, Banez LL, Presti JC, Jr., et al. Predictors of secondary treatment following biochemical recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital database. BJU Int. 2010;105:28-33.
https://doi.org/10.1111/j.1464-410X.2009.08684.x
Umezawa R, Ariga H, Ogawa Y, et al. Impact of pathological tumor stage for salvage radiotherapy after radical prostatectomy in patients with prostatespecific antigen < 1.0 ng/ml. Radiat Oncol. 2011;6:150.
https://doi.org/10.1186/1748-717X-6-150
Siegmann A, Bottke D, Faehndrich J, et al. Salvage radiotherapy after prostatectomy - What is the best time to treat? Radiother Oncol. 2012;103:239-43.
https://doi.org/10.1016/j.radonc.2011.10.024
Martin T, Wenz F, Bohmer D, et al. Radiation therapy for prostate cancer in the new S3 guideline. Part 2: postoperative radiation therapy and brachytherapy. Urologe A. 2010;49:216-20. [Artículo en alemán].
Wenz F, Martin T, Bohmer D, et al. The German S3 guideline prostate cancer: aspects for the radiation oncologist. Strahlenther Onkol. 2010;186:531-4.
https://doi.org/10.1007/s00066-010-2193-3
Budiharto T, Perneel C, Haustermans K, et al. A multiinstitutional analysis comparing adjuvant and salvage radiation therapy for high-risk prostate cancer patients with undetectable PSA after prostatectomy. Radiother Oncol. 2010;97:474-9.
https://doi.org/10.1016/j.radonc.2010.07.008
Pinto F, Prayer-Galetti T, Gardiman M, et al. Clinical and pathological characteristics of patients presenting with biochemical progression after radical retropubic prostatectomy for pathologically organ-confined prostate cancer. Urol Int. 2006;76:202-8.
https://doi.org/10.1159/000091619
Chun FK, Graefen M, Zacharias M, et al. Anatomic radical retropubic prostatectomy-long-term recurrence-free survival rates for localized prostate cancer. World J Urol. 2006;24:273-80.
https://doi.org/10.1007/s00345-006-0058-2
Swindle P, Eastham JA, Ohori M, et al. Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol. 2005;174:903-7.
https://doi.org/10.1097/01.ju.0000169475.00949.78
Salomon L, Anastasiadis AG, Antiphon P, et al. Prognostic consequences of the location of positive surgical margins in organ-confined prostate cancer. Urol Int. 2003;70:291-6.
https://doi.org/10.1159/000070138
Roehl KA, Han M, Ramos CG, et al. Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol. 2004;172:910-4.
https://doi.org/10.1097/01.ju.0000134888.22332.bb
Trabulsi EJ, Valicenti RK, Hanlon AL, et al. A multiinstitutional matched-control analysis of adjuvant and salvage postoperative radiation therapy for pT3-4N0 prostate cancer. Urology. 2008;72:1298-302.
https://doi.org/10.1016/j.urology.2008.05.057
Wiegel T, Lohm G, Bottke D, et al. Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome--results of a retrospective study. Int J Radiat Oncol Biol Phys. 2009;73:1009-16.
https://doi.org/10.1016/j.ijrobp.2008.06.1922
Ward JF, Zincke H, Bergstralh EJ, et al. Prostate specific antigen doubling time subsequent to radical prostatectomy as a prognosticator of outcome following salvage radiotherapy. J Urol. 2004;172:2244-8.
https://doi.org/10.1097/01.ju.0000145262.34748.2b
Coen JJ, Zietman AL, Thakral H, et al. Radical radiation for localized prostate cancer: local persistence of disease results in a late wave of metastases. J Clin Oncol. 2002;20:3199-205.
https://doi.org/10.1200/JCO.2002.01.086
Lightner DJ, Lange PH, Reddy PK, et al. Prostate specific antigen and local recurrence after radical prostatectomy. J Urol. 1990;144:921-6.
https://doi.org/10.1016/S0022-5347(17)39623-4
Van den Ouden D, Bentvelsen FM, Boeve ER, et al. Positive margins after radical prostatectomy: correlation with local recurrence and distant progression. Br J Urol. 1993;72:489-94.
https://doi.org/10.1111/j.1464-410X.1993.tb16183.x
Ospino R, Cendales R, Alonso CE. Braquiterapia de alta tasa de dosis en pacientes con cáncer de próstata. Rev. Colomb. Cancerol. 2008;12:30-3.
Peterson JL, Buskirk SJ, Heckman MG, et al. Late toxicity after postprostatectomy salvage radiation therapy. Radiother Oncol. 2009;93:203-6.
https://doi.org/10.1016/j.radonc.2009.08.035
Macdonald OK, Schild SE, Vora SA, et al. Radiotherapy for men with isolated increase in serum prostate specific antigen after radical prostatectomy. J Urol. 2003;170:1833-7.
How to Cite
Downloads
Downloads
Published
Issue
Section
License
Todos los derechos reservados.
