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Adjuvant versus early salvage radiation therapy in node positive prostate cancer patients: A long-term survival analysis
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
955
Adjuvant versus early salvage radiation therapy in node positive prostate cancer patients: A long-term survival analysis Eur Urol Suppl 2017; 16(3);e1663
Fossati N.1, Karnes R.J.2, Boorjian S.2, Colicchia M.2, Bossi A.3, Cozzarini C.4, Fiorino C.4, Chiorda B.N.4, Gandaglia G.1, Dell'Oglio P.1, Wiegel T.5, Shariat S.6, Goldner G.7, Joniau S.8, Battaglia A.8, Haustermans K.9, De Meerleer G.9, Fonteyne V.10, Ost P.10, Van Poppel H.5, Montorsi F.1, Briganti A.1 1
Vita-Salute University San Raffaele, Dept. of Urology, Milan, Italy, 2Mayo Clinic, Dept. of Urology, Rochester, United States of America, 3Gustave Roussy Institute, Dept. of Radiation Oncology, Villejuif, France, 4Vita-Salute University San Raffaele, Dept. of Radiotherapy, Milan, Italy, 5University Hospital Ulm, Dept. of Radiation Oncology, Ulm, Germany, 6Medical University of Vienna, Dept. of Urology, Vienna, Austria, 7Medical University of Vienna, Dept. of Radiation Oncology, Vienna, Austria, 8University Hospitals Leuven, Dept. of Urology, Leuven, Belgium, 9University Hospitals Leuven, Dept. of Radiotherapy, Leuven, Belgium, 10Ghent University Hospital, Dept. of Radiotherapy, Ghent, Belgium INTRODUCTION & OBJECTIVES: The role of post-prostatectomy radiation therapy (RT) in patients with pN1 prostate cancer is still under debate. However, whether adjuvant RT is equal to early salvage RT at long term in this setting is still unknown. In this study, we aimed at comparing the long-term effectiveness of adjuvant RT (aRT) versus early salvage RT (esRT). MATERIAL & METHODS: Using a multi-institutional cohort from six tertiary referral centres, we identified 171 pN1 patients who were treated with radical prostatectomy and pelvic lymph node dissection. Patients were stratified into two groups: aRT (Group 1) versus initial observation followed by esRT in case of PSA relapse (Group 2). Specifically, aRT was administered at undetectable PSA level within 6 months after RP, whereas esRT was administered at a PSA level ≤0.5 ng/ml. The clinical target volume included the pelvic lymph nodes area, prostatic and seminal vesicle bed in all patients receiving RT. The evaluated outcomes were metastasis-free and overall survival. Multivariable Cox regression analyses tested the association between groups (aRT vs. observation ± esRT) and the study outcomes. Covariates consisted of pathologic stage (≤pT3a vs. ≥pT3b), pathologic Gleason score (≤7 vs. ≥8), and surgical margin status (negative vs. positive). RESULTS: Overall, 85 (50%) and 86 (50%) patients underwent aRT and initial observation, respectively. Median follow-up (inter-quartile range) was similar among groups: 84 (44, 137) vs. 92 (38, 126) months (p=0.9). In group 2, 69 (80%) patients experienced PSA relapse and underwent esRT. Patients characteristics were not significantly different in terms of pathologic stage (≥pT3b: 60% vs. 53%, p=0.2), Gleason score (≥8: 44% vs. 41%, p=0.9), and positive surgical margins (59% vs. 55%, p=0.6). Concomitant hormonal therapy was administered to all patients treated with aRT, and to 44 out of 69 (64%) patients treated with esRT. Overall, 26 patients developed distant metastasis with the following distribution: retroperitoneal nodes (n=5), bone (n=19), and other organs (n=2). At last follow-up, 13 patients succumb to prostate cancer and 13 patients died for other cause. Metastasis-free survival (67% vs. 72% p=0.2) and overall survival (78% vs. 74%, p=0.8) at 8 years after RP were not significantly
Eur Urol Suppl 2017; 16(3);e1663
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
955
Adjuvant versus early salvage radiation therapy in node positive prostate cancer patients: A long-term survival analysis Eur Urol Suppl 2017; 16(3);e1664
different among groups. These results were confirmed at multivariable analyses for both distant metastasis (HR: 0.77; 95% CI: 0.24, 2.47; p=0.7) and overall survival (HR: 1.94; 95% CI: 0.58, 6.47; p=0.3). CONCLUSIONS: At long-term follow-up, timely administration of esRT showed comparable metastasisfree and overall survival to aRT. Even in pN1 patients, esRT may not thus compromise cancer control, while significantly reducing potential over-treatment associated with aRT.
Eur Urol Suppl 2017; 16(3);e1664 Powered by TCPDF (www.tcpdf.org)
955
Adjuvant versus early salvage radiation therapy in node positive prostate cancer patients: A long-term survival analysis Eur Urol Suppl 2017; 16(3);e1663
Fossati N.1, Karnes R.J.2, Boorjian S.2, Colicchia M.2, Bossi A.3, Cozzarini C.4, Fiorino C.4, Chiorda B.N.4, Gandaglia G.1, Dell'Oglio P.1, Wiegel T.5, Shariat S.6, Goldner G.7, Joniau S.8, Battaglia A.8, Haustermans K.9, De Meerleer G.9, Fonteyne V.10, Ost P.10, Van Poppel H.5, Montorsi F.1, Briganti A.1 1
Vita-Salute University San Raffaele, Dept. of Urology, Milan, Italy, 2Mayo Clinic, Dept. of Urology, Rochester, United States of America, 3Gustave Roussy Institute, Dept. of Radiation Oncology, Villejuif, France, 4Vita-Salute University San Raffaele, Dept. of Radiotherapy, Milan, Italy, 5University Hospital Ulm, Dept. of Radiation Oncology, Ulm, Germany, 6Medical University of Vienna, Dept. of Urology, Vienna, Austria, 7Medical University of Vienna, Dept. of Radiation Oncology, Vienna, Austria, 8University Hospitals Leuven, Dept. of Urology, Leuven, Belgium, 9University Hospitals Leuven, Dept. of Radiotherapy, Leuven, Belgium, 10Ghent University Hospital, Dept. of Radiotherapy, Ghent, Belgium INTRODUCTION & OBJECTIVES: The role of post-prostatectomy radiation therapy (RT) in patients with pN1 prostate cancer is still under debate. However, whether adjuvant RT is equal to early salvage RT at long term in this setting is still unknown. In this study, we aimed at comparing the long-term effectiveness of adjuvant RT (aRT) versus early salvage RT (esRT). MATERIAL & METHODS: Using a multi-institutional cohort from six tertiary referral centres, we identified 171 pN1 patients who were treated with radical prostatectomy and pelvic lymph node dissection. Patients were stratified into two groups: aRT (Group 1) versus initial observation followed by esRT in case of PSA relapse (Group 2). Specifically, aRT was administered at undetectable PSA level within 6 months after RP, whereas esRT was administered at a PSA level ≤0.5 ng/ml. The clinical target volume included the pelvic lymph nodes area, prostatic and seminal vesicle bed in all patients receiving RT. The evaluated outcomes were metastasis-free and overall survival. Multivariable Cox regression analyses tested the association between groups (aRT vs. observation ± esRT) and the study outcomes. Covariates consisted of pathologic stage (≤pT3a vs. ≥pT3b), pathologic Gleason score (≤7 vs. ≥8), and surgical margin status (negative vs. positive). RESULTS: Overall, 85 (50%) and 86 (50%) patients underwent aRT and initial observation, respectively. Median follow-up (inter-quartile range) was similar among groups: 84 (44, 137) vs. 92 (38, 126) months (p=0.9). In group 2, 69 (80%) patients experienced PSA relapse and underwent esRT. Patients characteristics were not significantly different in terms of pathologic stage (≥pT3b: 60% vs. 53%, p=0.2), Gleason score (≥8: 44% vs. 41%, p=0.9), and positive surgical margins (59% vs. 55%, p=0.6). Concomitant hormonal therapy was administered to all patients treated with aRT, and to 44 out of 69 (64%) patients treated with esRT. Overall, 26 patients developed distant metastasis with the following distribution: retroperitoneal nodes (n=5), bone (n=19), and other organs (n=2). At last follow-up, 13 patients succumb to prostate cancer and 13 patients died for other cause. Metastasis-free survival (67% vs. 72% p=0.2) and overall survival (78% vs. 74%, p=0.8) at 8 years after RP were not significantly
Eur Urol Suppl 2017; 16(3);e1663
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
955
Adjuvant versus early salvage radiation therapy in node positive prostate cancer patients: A long-term survival analysis Eur Urol Suppl 2017; 16(3);e1664
different among groups. These results were confirmed at multivariable analyses for both distant metastasis (HR: 0.77; 95% CI: 0.24, 2.47; p=0.7) and overall survival (HR: 1.94; 95% CI: 0.58, 6.47; p=0.3). CONCLUSIONS: At long-term follow-up, timely administration of esRT showed comparable metastasisfree and overall survival to aRT. Even in pN1 patients, esRT may not thus compromise cancer control, while significantly reducing potential over-treatment associated with aRT.
Eur Urol Suppl 2017; 16(3);e1664 Powered by TCPDF (www.tcpdf.org)