Clinical Outcomes of Postoperative Radiotherapy Following Radical Prostatectomy in Patients with Localized Prostate Cancer: A Multicenter Retrospective Study (KROG 18-01) of a Korean Population
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Purpose The purpose of this study was to investigate the clinical outcomes of postoperative radiotherapy (PORT) patients who underwent radical prostatectomy for localized prostate cancer. Materials and Methods Localized prostate cancer patients who received PORT after radical prostatectomy between 2001 and 2012 were identified retrospectively in a multi-institutional database. In total, 1,117 patients in 19 institutions were included. Biochemical failure after PORT was defined as prostate-specific antigen (PSA) ! nadir+2 after PORT or initiation of androgen deprivation therapy (ADT) for increasing PSA regardless of its value. Results Ten-year biochemical failure-free survival, clinical failure-free survival, distant metastasisfree survival, overall survival (OS), and cause-specific survival were 60.5%, 76.2%, 84.4%, 91.1%, and 96.6%, respectively, at a median of 84 months after PORT. Pre-PORT PSA " 0.5 ng/ml and Gleason’s score " 7 predicted favorable clinical outcomes, with 10-year OS rates of 92.5% and 94.1%, respectively. The 10-year OS rate was 82.7% for patients with a PSA > 1.0 ng/mL and 86.0% for patients with a Gleason score of 8-10. The addition of longterm ADT (! 12 months) to PORT improved OS, particularly in those with a Gleason score of 8-10 or ! T3b. Conclusion Clinical outcomes of PORT in a Korean prostate cancer population were very similar to those in Western countries. Lower Gleason score and serum PSA level at the time of PORT were significantly associated with favorable outcomes. Addition of long-term ADT (! 12 months) to PORT should be considered, particularly in unfavorable risk patients with Gleason scores of 8-10 or ! T3b.
Abstract
Purpose The purpose of this study was to investigate the clinical outcomes of postoperative radiotherapy (PORT) patients who underwent radical prostatectomy for localized prostate cancer. Materials and Methods Localized prostate cancer patients who received PORT after radical prostatectomy between 2001 and 2012 were identified retrospectively in a multi-institutional database. In total, 1,117 patients in 19 institutions were included. Biochemical failure after PORT was defined as prostate-specific antigen (PSA) ! nadir+2 after PORT or initiation of androgen deprivation therapy (ADT) for increasing PSA regardless of its value. Results Ten-year biochemical failure-free survival, clinical failure-free survival, distant metastasisfree survival, overall survival (OS), and cause-specific survival were 60.5%, 76.2%, 84.4%, 91.1%, and 96.6%, respectively, at a median of 84 months after PORT. Pre-PORT PSA " 0.5 ng/ml and Gleason’s score " 7 predicted favorable clinical outcomes, with 10-year OS rates of 92.5% and 94.1%, respectively. The 10-year OS rate was 82.7% for patients with a PSA > 1.0 ng/mL and 86.0% for patients with a Gleason score of 8-10. The addition of longterm ADT (! 12 months) to PORT improved OS, particularly in those with a Gleason score of 8-10 or ! T3b. Conclusion Clinical outcomes of PORT in a Korean prostate cancer population were very similar to those in Western countries. Lower Gleason score and serum PSA level at the time of PORT were significantly associated with favorable outcomes. Addition of long-term ADT (! 12 months) to PORT should be considered, particularly in unfavorable risk patients with Gleason scores of 8-10 or ! T3b.
참고문헌 (29)
- Roehl KA, "Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3, 478 consecutive patients : long-term results", J Urol, 172, pp.910~914 (2004)
- Pound CR, "Natural history of progression after PSA elevation following radical prostatectomy", JAMA, 281, pp.1591~1597 (1999)
- Trock BJ, "Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy", JAMA, 299, pp.2760~2769 (2008)
- Cotter SE, "Salvage radiation in men after prostate-specific antigen failure and the risk of death", Cancer, 117, pp.3925~3932 (2011)
- Bolla M, "Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer : long-term results of a randomised controlled trial(EORTC trial 22911)", Lancet, 380, pp.2018~2027 (2012)
- Thompson IM, "Adjuvant radiotherapy for pathological T3N0-M0 prostate cancer significantly reduces risk of metastases and improves survival : long-term followup of a randomized clinical trial", J Urol, 181, pp.956~962 (2009)
- Freedland SJ, "Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy", JAMA, 294, pp.433~439 (2005)
- Pollack A, "Radiation Therapy Oncology Group RTOG 0534: a phase III trial of short term androgen deprivation with pelvic lymph node or prostate bed only radiotherapy (SPPORT)in prostate cancer patients with a rising PSA after radical prostatectomy", RTOG Foundation, ~ (2011)
- Mohler JL, "Prostate cancer, version 1.2016", J Natl Compr Canc Netw, 14, pp.19~30 (2016)
- Ghadjar P, "Acute toxicity and quality of life after dose-intensified salvage radiation therapy for biochemically recurrent prostate cancer after prostatectomy : first results of the randomized trial SAKK 09", 10, 2015, pp.33, 4158~4166
- Stish BJ, "Improved metastasis-free and survival outcomes with early salvage radiotherapy in men with detectable prostatespecific antigen after prostatectomy for prostate cancer", J Clin Oncol, 34, pp.3864~3871 (2016)
- Stephenson AJ, "Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy", J Clin Oncol, 25, pp.2035~2041 (2007)
- Stephenson AJ, "Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy", JAMA, 291, pp.1325~1332 (2004)
- Maurice MJ, "Low use of immediate and delayed postoperative radiation for prostate cancer with adverse pathological features", J Urol, 194, pp.972~976 (2015)
- Briganti A, "Early salvage radiation therapy does not compromise cancer control in patients with pT3N0 prostate cancer after radical prostatectomy : results of a match-controlled multiinstitutional analysis", Eur Urol, 62, pp.472~487 (2012)
- Zietman AL, "Comparison of conventional-dose vs highdose conformal radiation therapy in clinically localized adenocarcinoma of the prostate : a randomized controlled trial", JAMA, 294, pp.1233~1239 (2005)
- King CR, "Radiotherapy after prostatectomy : is the evidence for dose escalation out there", Int J Radiat Oncol Biol Phys, 71, pp.346~350 (2008)
- Bernard JR Jr, "Salvage radiotherapy for rising prostatespecific antigen levels after radical prostatectomy for prostate cancer : dose-response analysis", Int J Radiat Oncol Biol Phys, 76, pp.735~740 (2010)
- Cozzarini C, "Need for high radiation dose(! 70 gy)in early postoperative irradiation after radical prostatectomy : a singleinstitution analysis of 334 high-risk, node-negative patients", Int J Radiat Oncol Biol Phys, 75, pp.966~974 (2009)
- Latacz E, "EP-1597: Dose-escalation for early salvage radiotherapy in prostate cancer improves bDFS", Radiother Oncol, 127(Suppl 1), pp.S859~S860 (2018)
- Caubet M, "The role of whole pelvic nodal radiotherapy compared with prostate bed only radiotherapy after radical prostatectomy for prostate cancer", J Clin Oncol, 36(6Suppl), pp.93~ (2018)
- "Short term androgen deprivation therapy without or with pelvic lymph node treatment added to prostate bed only salvage radiation therapy: The NRG Oncology/RTOG 0534 SPPORT Trial" (2018)[URL]
- McLaughlin PW, "ACR Appropriateness Criteria(R)locally advanced, high-risk prostate cancer", Am J Clin Oncol, 40, pp.1~10 (2017)
- 이성욱, "Multimodal therapy for locally advanced prostate cancer: the roles of radiotherapy, androgen deprivation therapy,and their combination", Radiation oncology journal, 35(3), pp.189~197 (2017), 대한방사선종양학회
- Shipley WU, "Radiation with or without antiandrogen therapy in recurrent prostate cancer", N Engl J Med, 376, pp.417~428 (2017)
- Carrie C, "Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy(GETUG-AFU 16) : a randomised, multicentre, open-label phase 3 trial", Lancet Oncol, 17, pp.747~756 (2016)
- Cozzarini C, "Clinical factors predicting late severe urinary toxicity after postoperative radiotherapy for prostate carcinoma : a single-institute analysis of 742 patients", Int J Radiat Oncol Biol Phys, 82, pp.191~199 (2012)
- Poortmans P, "Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group", Radiother Oncol, 84, pp.121~127 (2007)
- Dearnaley DP, "Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer : a randomised trial", Lancet, 353, pp.267~272 (1999)