Role of postoperative radiotherapy after pelvic lymphadenectomy and radical retropubic prostatectomy: a single institute experience of 415 patients
Preliminary results published in part in abstract form (Cozzarini C, et al. Role of postoperative radiotherapy after pelvic lymphadenectomy and radical prostatectomy: a single institution experience on 410 patients. Int J Radiat Oncol Biol Phys 2002;54(Suppl. 1):63) and reported as an oral presentation during the 44th American Society for Therapeutic Radiology and Oncology Annual Meeting, October 4–8, 2002, New Orleans, LA.
Received 11 June 2003; received in revised form 6 October 2003; accepted 2 December 2003.
Abstract
Purpose
To evaluate the clinical benefit deriving from early (within 6 months) radiotherapy (ERT) after pelvic lymphadenectomy and radical retropubic prostatectomy for localized/locally advanced adenocarcinoma of the prostate in a single-institution series.
Methods and materials
We retrospectively analyzed 415 patients who underwent pelvic lymphadenectomy and radical retropubic prostatectomy between 1986 and 1998 for pT2b-pT4, pN0-pN1 prostate carcinoma. Of the 415 patients, 237 underwent ERT for adverse pathologic findings and 178 patients did not receive RT or underwent salvage RT ≤6 months (salvage or no RT [SNRT]).
Results
After a median follow-up of 62 months, the 8-year actuarial freedom from biochemical, local and systemic failure, and cause-specific survival rate was 69% vs. 31% (p <0.0001, log–rank), 93% vs. 63% (p <0.0001), 88% vs. 75% (p = 0.04), and 93% vs. 80% (p = 0.02) in the ERT and SNRT group, respectively. A subgroup analysis indicated that an improvement in 8-year actuarial cause-specific survival was associated with ERT in patients with positive resection margins (91% vs. 67%, p = 0.007), extracapsular extension (92% vs. 75%, p = 0.002), Gleason score ≥7 (88% vs. 72%, p = 0.02), and lymph node metastases (88% vs. 68%, p = 0.04). This strong association between ERT and cause-specific survival persisted at multivariate analysis in the whole group of patients examined (hazard ratio, 4.3) and in the subgroups of patients with extracapsular extension (hazard ratio, 4.9), positive resection margins (hazard ratio, 4.7), Gleason score ≥7 (hazard ratio, 4.4), and lymph node metastases (hazard ratio, 7.4).
Conclusion
The results of this retrospective analysis indicate that ERT after pelvic lymphadenectomy and radical retropubic prostatectomy improved the 5-year and actuarial 8-year cause-specific survival of patients with adverse pathologic findings such as extracapsular extension, positive resection margins, Gleason score ≥7, and/or positive lymph nodes.
*Department of Radiochemotherapy, San Raffaele H Scientific Institute, Milan, Italy
†Department of Medical Physics, San Raffaele H Scientific Institute, Milan, Italy
‡Department of Urology, San Raffaele H Scientific Institute, Milan, Italy
Reprint requests to: Cesare Cozzarini, M.D., Department of Radiochemotherapy, San Raffaele H Scientific Institute, Via Olgettina 60, Milan 20132 Italy. Tel: (+39) 02-2643-7649; Fax: (+39) 02-2643-7603
ABSTRACT