Adjuvant, Early Salvage and Salvage Radiotherapy after surgery in prostate cancer: survival outcomes
PO-1404
Abstract
Adjuvant, Early Salvage and Salvage Radiotherapy after surgery in prostate cancer: survival outcomes
Authors: Ilaria Angelicone1, Alfredo Priore1, Francesca Perrone Congedi1, Flavia de Giacomo1, Barbara Campanella1, Mattia Falchetto Osti1, Maurizio Valeriani1
1Sapienza Università, A.O.U. Sant'Andrea, U.O. Radioterapia Oncologica, Roma, Italy
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Purpose or Objective
Endpoints of this retrospective study in terms of clinical outcomes were Overall Survival (OS), Biochemical-Free Survival (BFS) and Radiological Progression Free Survival (RPFS) of patients (pts) with histologically confirmed prostate cancer treated with post-operative radiotherapy after radical prostatectomy.
Material and Methods
Our casistic involved 154 pts with a median age of 65 years (range 49-79), underwent adjuvant (36%), early-salvage (30%) and salvage radiotherapy (34%) between March 2011 and March 2020. RT was performed with Intensity Modulated Radiotherapy (IMRT)/Volumetric Modulated Arc Therapy (VMAT) technique and dose varied from 62.5 to 70 Gy. Pts with a PSA value after surgery under 0.2 ng/dL and unfavorable histopathological characteristics (neoplastic invasion of seminal vesicles or extracapsular extension of neoplasm) were assigned to receive Adjuvant Radiotherapy (ART), pts with a PSA value between 0.2 and 0.5 ng/dL were treated with Early Salvage Radiotherapy (ESRT) and pts with a PSA value over 0.5 ng/dL or positive surgical margins received Salvage Radiotherapy (SRT). Univariate analysis (log rank) were assessed with Chi-square test and Kaplan-Meier method.
Results
Median follow-up was 70.3 months (range 11.3-121.4). OS at 5 and 8 years was 95.5% and 84.3% respectively for all pts included, with significant statistical difference (p=0.043) between pts treated with ESRT (OS at 5 and 8 ys = 97,7%) and SRT (OS at 5 ys = 95.5%; at 8 ys = 70.8%). BFS in the whole population was 71% at 5 years and 68,3% at 8 years, with a statistically significant difference (p=0,011) between pts treated with ART (BFS at 5 and 8 ys = 82.2%) and SRT (BFS at 5 ys = 61.3%; at 8 ys = 58.5%). RPFS was 85.7% at 5 years and 83.4% at 8 years: the same results were observed also in this case, with a statistically significant difference between pts treated with ESRT (RPFS at 5 and 8 ys = 95.7%) and SRT (RPFS at 5 ys = 73.3%; at 8 ys 67.3%; p=0.03).
Conclusion
Our analysis demonstrates that patients underwent Adjuvant RT have better survival outcome then patients treated with Salvage RT in terms of biochemical-free survival. A statistically significant difference is also demonstrated between patients treated with Early Salvage RT, that shows an improved overall survival and radiological progression-free survival, and Salvage RT.