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Adjuvant and Salvage Radiotherapy After Prostatectomy for Prostate Cancer: A Literature Review

      Purpose

      Given that postprostatectomy recurrence of prostate cancer occurs in 10–40% of patients, the best use of immediate postoperative radiotherapy (RT) in high-risk patients and salvage RT for biochemical recurrence remains a topic of debate. We assessed the levels of evidence (in terms of efficacy, prognostic factors, and toxicity) for the following treatment strategies: immediate postoperative RT alone, salvage RT alone, and the addition of androgen deprivation therapy to the two RT strategies.

      Methods and Materials

      A systematic literature search for controlled randomized trials, noncontrolled trials, and retrospective studies between 1990 and 2008 was performed on PubMed, CancerLit, and MEDLINE. Only relevant articles that had appeared in peer-reviewed journals were selected. We report on the levels of evidence (according to the National Cancer Institute guidelines) supporting the various treatment strategies.

      Results

      Immediate postoperative RT improves biochemical and clinical progression-free survival (Level of evidence, 1.ii) but has no significant effect on metastasis-free survival or overall survival. A pathologic review is of particular importance for correctly analyzing the treatment strategies. Low-grade morbidity has been significantly greater in the postoperative groups, but no severe toxicity has been observed. The influence of immediate postoperative RT on postprostatectomy continence appears to be slight; therefore, immediate postoperative RT should be considered in patients with major risk factors for local relapse (Level of evidence, 1.ii). On the basis of extensive retrospective data, salvage RT is effective in biochemical relapse after prostatectomy; some patients with few adverse prognostic factors might also benefit from salvage RT (Level of evidence, 3.ii). The addition of androgen deprivation therapy to immediate postoperative or salvage RT has only been supported by weak, retrospective data (Level of evidence, 3.ii).

      Conclusion

      Prospective randomized trials are needed to compare immediate postoperative RT with salvage RT and to assess the value of androgen deprivation therapy in this setting.
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      5. RTOG trial 0534: A phase III trial of short term androgen deprivation with pelvic lymph node or prostate only radiotherapy (SPORT) in prostate cancer patients with a rising PSA after radical prostatectomy. Available from: http://www.rtog.org/. Accessed June 27, 2008.

      6. GETUG 16 trial: Phase III randomized study of adjuvant radiotherapy with versus without concurrent goserelin in patients who have undergone surgery for recurrent or refractory prostate cancer. Available from: http://www.cancer.gov/clinicaltrials. Accessed June 27, 2008.

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