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Optimal timing of post-prostatectomy radiotherapy for prostate cancer with high-risk pathologic features: A multi-institutional analysis.

Publication ,  Conference
Hwang, WL; Tendulkar, RD; Niemierko, A; Agrawal, S; Stephans, KL; Spratt, DE; Hearn, JWD; Koontz, BF; Lee, WR; Michalski, JM; Pisansky, TM ...
Published in: Journal of Clinical Oncology
February 20, 2018

24 Background: The use of radical prostatectomy (RP) as initial treatment of high-risk/locally-advanced prostate cancer is increasing but patients (pts) with adverse pathologic features such as positive surgical margins or T3 disease have up to 70% recurrence risk. These high-risk pts may be managed with adjuvant radiotherapy (ART) or early salvage radiotherapy (ESRT). The optimal timing of post-operative radiotherapy is unclear. Methods: Individual data from 1566 consecutive pts with pT2N0M0/R1 or pT3N0M0/R0-1 disease who underwent post-prostatectomy ART or ESRT (1987-2013) at 10 academic centers were pooled. Post-irradiation freedom from biochemical failure (FFBF), freedom from distant metastases (FFDM), prostate-cancer specific survival (PCSS), and overall survival (OS) were compared using Kaplan-Meier and multivariate competing-risks regression (MVA) analyses. Propensity score (PS) matching was used to account for covariates potentially associated with treatment allocation. All outcomes were measured from the date of surgery to address lead time bias. Results: After PS-matching, median follow-up after surgery was 66 vs. 73 months for the ART and ESRT groups, respectively, and baseline characteristics were well-matched. ART was associated with higher FFBF (12-yr: 69% vs. 43%; log-rank P < 0.0001), FFDM (12-yr: 95% vs. 85%; log-rank P = 0.03), PCSS (12-yr: 99% vs. 94%; log-rank P = 0.048), and OS (12-yr: 91% vs. 79%; log-rank P = 0.01). ART, lower Gleason score, lower T-stage, nodal irradiation, and postoperative androgen deprivation therapy were favorable prognostic features on MVA for BF. Sensitivity analysis demonstrated that the decreased risk of BF associated with ART remained significant unless more than 56% of ART pts were cured by surgery alone. This threshold is greater than the estimated 12-yr FFBF of 46% after RP alone as determined by a contemporary nomogram. Conclusions: To the best of our knowledge, this represents the largest multi-institutional study to date comparing ART to ESRT. ART was associated with reduced biochemical recurrence, distant metastases, and death compared to ESRT for high-risk pts, pending prospective validation.

Duke Scholars

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

February 20, 2018

Volume

36

Issue

6_suppl

Start / End Page

24 / 24

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hwang, W. L., Tendulkar, R. D., Niemierko, A., Agrawal, S., Stephans, K. L., Spratt, D. E., … Efstathiou, J. A. (2018). Optimal timing of post-prostatectomy radiotherapy for prostate cancer with high-risk pathologic features: A multi-institutional analysis. In Journal of Clinical Oncology (Vol. 36, pp. 24–24). American Society of Clinical Oncology (ASCO). https://doi.org/10.1200/jco.2018.36.6_suppl.24
Hwang, William L., Rahul D. Tendulkar, Andrzej Niemierko, Shree Agrawal, Kevin L. Stephans, Daniel Eidelberg Spratt, Jason W. D. Hearn, et al. “Optimal timing of post-prostatectomy radiotherapy for prostate cancer with high-risk pathologic features: A multi-institutional analysis.” In Journal of Clinical Oncology, 36:24–24. American Society of Clinical Oncology (ASCO), 2018. https://doi.org/10.1200/jco.2018.36.6_suppl.24.
Hwang WL, Tendulkar RD, Niemierko A, Agrawal S, Stephans KL, Spratt DE, et al. Optimal timing of post-prostatectomy radiotherapy for prostate cancer with high-risk pathologic features: A multi-institutional analysis. In: Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2018. p. 24–24.
Hwang, William L., et al. “Optimal timing of post-prostatectomy radiotherapy for prostate cancer with high-risk pathologic features: A multi-institutional analysis.Journal of Clinical Oncology, vol. 36, no. 6_suppl, American Society of Clinical Oncology (ASCO), 2018, pp. 24–24. Crossref, doi:10.1200/jco.2018.36.6_suppl.24.
Hwang WL, Tendulkar RD, Niemierko A, Agrawal S, Stephans KL, Spratt DE, Hearn JWD, Koontz BF, Lee WR, Michalski JM, Pisansky TM, Liauw SL, Abramowitz M, Pollack A, Moghanaki D, Anscher M, Den RB, Zietman AL, Stephenson AJ, Efstathiou JA. Optimal timing of post-prostatectomy radiotherapy for prostate cancer with high-risk pathologic features: A multi-institutional analysis. Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2018. p. 24–24.

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

February 20, 2018

Volume

36

Issue

6_suppl

Start / End Page

24 / 24

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences