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Late toxicity from salvage radiation therapy for prostate cancer: intensity-modulated radiation therapy vs. 3D-conformal radiation therapy

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

This study aims to compare late toxicity in patients undergoing salvage radiation therapy (SRT) for a detectable prostate-specific antigen level after radical prostatectomy between those who received low-dose three-dimensional-conformal radiation therapy (3D-CRT), high-dose 3D-CRT and intensity-modulated radiation therapy (IMRT).

Methods

We retrospectively identified 266 patients who underwent SRT at our institution. Patients were categorized into three groups: low-dose 3D-CRT (≤66.6 Gy, N = 142), high-dose 3D-CRT (>66.6 Gy, N = 49), and high-dose IMRT (>66.6 Gy, N = 75). Low-dose IMRT patients were not included due to their small number (N = 22). Late toxicity was defined as occurring 90 days or more after SRT completion.

Results

The cumulative incidence of any late complication at 5 years after SRT was 11.0 % for the low-dose 3D-CRT group, 18.8 % for the high-dose 3D-CRT group, and 14.7 % for the high-dose IMRT group, with no significant differences between groups (P ≥ 0.17). No significant difference between groups was found in the occurrence of any specific complication, although there were nonsignificant trends toward an increased incidence of diarrhea at 5 years in the high-dose 3D-CRT group (7.0 %) compared with the low-dose 3D-CRT (1.4 %, P = 0.061) and high-dose IMRT groups (0.0 %, P = 0.068), and more grade 2+ late complications in the high-dose 3D-CRT group (14.0 %) than the low-dose 3D-CRT group (6.0 %, P = 0.059).

Conclusion

Our results indicate that with the advancement in planning and delivery of SRT, it is possible to administer IMRT at higher doses without significantly increasing the risk of late complications. Future studies involving larger numbers of high-dose IMRT patients will further strengthen these findings.

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References

  1. De Meerleer G, Fonteyne V, Meersschout S, Van den Broecke C, Villeirs G, Lumen N, Ost P, Vandecasteele K, De Neve W (2008) Salvage intensity-modulated radiotherapy for rising PSA after radical prostatectomy. Radiother Oncol 89:205–213

    Article  PubMed  Google Scholar 

  2. Pisansky TM, Kozelsky TF, Myers RP, Hillman DW, Blute ML, Buskirk SJ, Cheville JC, Ferrigni RG, Schild SE (2000) Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer. J Urol 163:845–850

    Article  CAS  PubMed  Google Scholar 

  3. Ward JF, Zincke H, Bergstralh EJ, Slezak JM, Blute ML (2004) Prostate specific antigen doubling time subsequent to radical prostatectomy as a prognosticator of outcome following salvage radiotherapy. J Urol 172:2244–2248

    Article  PubMed  Google Scholar 

  4. Pazona JF, Han M, Hawkins SA, Roehl KA, Catalona WJ (2005) Salvage radiation therapy for prostate specific antigen progression following radical prostatectomy: 10-year outcome estimates. J Urol 174:1282–1286

    Article  PubMed  Google Scholar 

  5. Chawla AK, Thakral HK, Zietman AL, Shipley WU (2002) Salvage radiotherapy after radical prostatectomy for prostate adenocarcinoma: analysis of efficacy and prognostic factors. Urology 59:726–731

    Article  PubMed  Google Scholar 

  6. Bernard JR Jr, Buskirk SJ, Heckman MG, Diehl NN, Ko SJ, Macdonald OK, Schild SE, Pisansky TM (2010) Salvage radiotherapy for rising prostate-specific antigen levels after radical prostatectomy for prostate cancer: dose–response analysis. Int J Radiat Oncol Biol Phys 76:735–740

    Article  PubMed  Google Scholar 

  7. King CR, Spiotto MT (2008) Improved outcomes with higher doses for salvage radiotherapy after prostatectomy. Int J Radiat Oncol Biol Phys 71:23–27

    Article  PubMed  Google Scholar 

  8. Wong GW, Palazzi-Churas KL, Jarrard DF, Paolone DR, Graf AK, Hedican SP, Wegenke JD, Ritter MA (2008) Salvage hypofractionated radiotherapy for biochemically recurrent prostate cancer after radical prostatectomy. Int J Radiat Oncol Biol Phys 70:449–455

    Article  CAS  PubMed  Google Scholar 

  9. US Department of Health and Human Services; National Institutes of Health; National Cancer Institute. Common terminology criteria for adverse events (CTCAE): version 4.0. 2009 May 28. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf. Accessed: 10 Oct 2011

  10. Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D’Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen C, Thrasher JB, Thompson I (2007) Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol 177:540–545

    Article  CAS  PubMed  Google Scholar 

  11. Buskirk SJ, Pisansky TM, Schild SE, Macdonald OK, Wehle MJ, Kozelsky TF, Collie AC, Ferrigni RG, Myers RP, Prussak KA, Heckman MG, Crook JE, Parker AS, Igel TC (2006) Salvage radiotherapy for isolated prostate specific antigen increase after radical prostatectomy: evaluation of prognostic factors and creation of a prognostic scoring system. J Urol 176:985–990

    Article  PubMed  Google Scholar 

  12. Macdonald OK, Schild SE, Vora SA, Andrews PE, Ferrigni RG, Novicki DE, Swanson SK, Wong WW (2003) Radiotherapy for men with isolated increase in serum prostate specific antigen after radical prostatectomy. J Urol 170:1833–1837

    Article  PubMed  Google Scholar 

  13. Maier J, Forman J, Tekyi-Mensah S, Bolton S, Patel R, Pontes JE (2004) Salvage radiation for a rising PSA following radical prostatectomy. Urol Oncol 22:50–56

    Article  PubMed  Google Scholar 

  14. Feng M, Hanlon AL, Pisansky TM, Kuban D, Catton CN, Michalski JM, Zelefsky MJ, Kupelian PA, Pollack A, Kestin LL, Valicenti RK, DeWeese TL, Sandler HM (2007) Predictive factors for late genitourinary and gastrointestinal toxicity in patients with prostate cancer treated with adjuvant or salvage radiotherapy. Int J Radiat Oncol Biol Phys 68:1417–1423

    Article  PubMed  Google Scholar 

  15. Choo R, Pearse M, Danjoux C, Gardner S, Morton G, Szumacher E, Loblaw DA, Cheung P (2008) Analysis of gastrointestinal and genitourinary morbidity of postoperative radiotherapy for pathologic T3 disease or positive surgical margins after radical prostatectomy using National Cancer Institute expanded common toxicity criteria. Int J Radiat Oncol Biol Phys 72:989–995

    Article  PubMed  Google Scholar 

  16. Pearse M, Choo R, Danjoux C, Gardner S, Morton G, Szumacher E, Loblaw A, Cheung P (2008) Prospective assessment of gastrointestinal and genitourinary toxicity of salvage radiotherapy for patients with prostate-specific antigen relapse or local recurrence after radical prostatectomy. Int J Radiat Oncol Biol Phys 72:792–798

    Article  PubMed  Google Scholar 

  17. Peterson JL, Buskirk SJ, Heckman MG, Crook JE, Ko SJ, Wehle MJ, Igel TC, Prussak KA, Pisansky TM (2009) Late toxicity after postprostatectomy salvage radiation therapy. Radiother Oncol 93:203–206

    Article  PubMed  Google Scholar 

  18. Nath SK, Sandhu AP, Rose BS, Simpson DR, Nobiensky PD, Wang JZ, Millard F, Kane CJ, Parsons JK, Mundt AJ (2010) Toxicity analysis of postoperative image-guided intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 78:435–441

    Article  PubMed  Google Scholar 

  19. Goenka A, Magsanoc JM, Pei X, Schechter M, Kollmeier M, Cox B, Scardino PT, Eastham JA, Zelefsky MJ (2011) Improved toxicity profile following high-dose postprostatectomy salvage radiation therapy with intensity-modulated radiation therapy. Eur Urol 60:1142–1148

    Article  PubMed  Google Scholar 

  20. Michalski JM, Lawton C, El Naqa I, Ritter M, O’Meara E, Seider MJ, Lee WR, Rosenthal SA, Pisansky T, Catton C, Valicenti RK, Zietman AL, Bosch WR, Sandler H, Buyyounousky MK, Ménard C (2010) Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 76:361–368

    Article  PubMed Central  PubMed  Google Scholar 

  21. Radiation Therapy Oncology Group (RTOG) (Internet). Philadelphia: RTOG, 2008. Shipley WU, Lukka H, Major P, Heney NM, Grignon D; Radiation Therapy Oncology Group RTOG 96-01. A phase III trial of radiation therapy with or without casodex in patients with PSA elevation following radical prostatectomy for pT3N0 carcinoma of the prostate. 17 Jul 2011. http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=9601

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Conflict of interest statement

Katherine S. Tzou, Steven J. Buskirk, Michael G. Heckman, Jennifer L. Peterson, Richard J. Lee, Nitesh N. Paryani, Stephen J. Ko, Larry C. Daugherty, and Laura A. Vallow declare that they have no conflict of interest.

Ethical standards

This retrospective series does not contain any studies with human or animal subjects performed by any of the authors.

Funding source

There was no funding source for this study.

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Correspondence to Katherine S. Tzou.

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Tzou, K.S., Buskirk, S.J., Heckman, M.G. et al. Late toxicity from salvage radiation therapy for prostate cancer: intensity-modulated radiation therapy vs. 3D-conformal radiation therapy. J Radiat Oncol 3, 89–97 (2014). https://doi.org/10.1007/s13566-013-0105-8

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  • DOI: https://doi.org/10.1007/s13566-013-0105-8

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