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Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy

  • Authors:
    • Jeff R. Cortés-González
    • Enrique Castellanos
    • Katinka Sandberg
    • Marie-Hjelm Eriksson
    • Peter Wiklund
    • Stefan Carlsson
    • Gabriella Cohn-Cedermark
    • Ulrika Harmenberg
    • Ove Gustafsson
    • Seymour H. Levitt
    • Bo Lennernäs
    • Yvonne Brandberg
    • Marcela Márquez
    • Karl-Mikael Kälkner
    • Sten Nilsson

  • View Affiliations

  • Published online on: November 13, 2012     https://doi.org/10.3892/ijo.2012.1694
  • Pages: 109-117
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Abstract

The aim of this study was to investigate the role of 70 Gy salvage radiotherapy (SRT) combined with short-term neoadjuvant hormonal therapy (NHT) in the treatment of recurrent disease after radical prostatectomy (RP), and to consider quality of life (QoL), survival outcomes and impact of co-morbidities on treatment-related rectal-genitourinary toxicity. Electronic records of 184 SRT patients treated consecutively between October 2001 and February 2007 were analyzed. Median age was 64 years (median follow-up 48 months). NHT was given to 165 patients (median 3 months). Pre-RP and pre-SRT PSA, PSA doubling time, Gleason score (GS), seminal vesicle invasion (SVI) and detectable post-SRT PSA were recorded. Any detectable PSA or PSA >0.1 ng/ml + nadir was considered biochemical failure (BcF). The Charlson co-morbidity index was used to correlate co-morbidities and rectal-genitourinary toxicity. Scores from the health-related QoL EORTC QLQ-C30 and PR-25 questionnaires were also evaluated. In 116 (63%) patients, a long-lasting curative effect was indicated by undetectable PSA levels. In univariate analysis, using BcF as an outcome variable, p<0.001 was found for GS, pre-SRT PSA, SVI and detectable post-SRT PSA. Multivariate analysis showed p=0.01 for SVI, p=0.09 for GS, and detectable post-SRT PSA (p=0.01); with metastases as an outcome variable, only SVI was significant (p=0.007). Cancer-specific and overall survival were 99 and 95%, respectively. Although microscopy showed SVI or GS 8-10 in the prostatectomy specimens 17/40 (43%) and 13/29 (45%), respectively, of patients still showed undetectable PSA at long-term follow-up (median 55 months) after SRT. Likewise, 11/31 (36%) patients with pre-SRT PSA >1.0 ng/ml and 80/134 (60%) patients with PSA doubling time (PSADT) <10 still showed undetectable PSA after 50 months. Slightly elevated acute and late rectal-genitourinary grade 3-4 toxicity was observed. No association with co-morbidity/toxicity was found. EORTC QLQ-C30 scores were similar to or slightly better than reference values. SRT with 70 Gy combined with 3-month NHT results in long-term undetectable PSA in >50% of patients with recurrence after RP with acceptable rectal-genitourinary toxicity and without negatively affecting long-term QoL. Non-metastatic patients should not be disqualified from receiving SRT although presenting with poor prognostic factors at surgery.
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January 2013
Volume 42 Issue 1

Print ISSN: 1019-6439
Online ISSN:1791-2423

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Spandidos Publications style
Cortés-González JR, Castellanos E, Sandberg K, Eriksson M, Wiklund P, Carlsson S, Cohn-Cedermark G, Harmenberg U, Gustafsson O, Levitt SH, Levitt SH, et al: Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy. Int J Oncol 42: 109-117, 2013.
APA
Cortés-González, J.R., Castellanos, E., Sandberg, K., Eriksson, M., Wiklund, P., Carlsson, S. ... Nilsson, S. (2013). Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy. International Journal of Oncology, 42, 109-117. https://doi.org/10.3892/ijo.2012.1694
MLA
Cortés-González, J. R., Castellanos, E., Sandberg, K., Eriksson, M., Wiklund, P., Carlsson, S., Cohn-Cedermark, G., Harmenberg, U., Gustafsson, O., Levitt, S. H., Lennernäs, B., Brandberg, Y., Márquez, M., Kälkner, K., Nilsson, S."Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy". International Journal of Oncology 42.1 (2013): 109-117.
Chicago
Cortés-González, J. R., Castellanos, E., Sandberg, K., Eriksson, M., Wiklund, P., Carlsson, S., Cohn-Cedermark, G., Harmenberg, U., Gustafsson, O., Levitt, S. H., Lennernäs, B., Brandberg, Y., Márquez, M., Kälkner, K., Nilsson, S."Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy". International Journal of Oncology 42, no. 1 (2013): 109-117. https://doi.org/10.3892/ijo.2012.1694