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Abstract
Objectives: To assess the clinical outcomes of prostate cancer patients treated with salvage radiotherapy (SRT) for locoregional clinical recurrence (CR) after radical prostatectomy (RP). Methods: Records of 60 patients with macroscopic locoregional recurrence after prostatectomy and referrals for SRT were retrospectively investigated in the multi-institutional database. The median radiation dose was 70.2 Gy. Biochemical failure was defined as the prostate-specific antigen (PSA) ≥ nadir + 2 or initiation of androgen deprivation therapy (ADT) for increased PSA. Results: Median recurrent tumor size was 1.1 cm and pre-radiotherapy PSA level was 0.4 ng/ml. At a median follow-up of 83.1-month after SRT, 7-year biochemical failure-free survival (BCFFS), locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and overall survival (OS) were 67.0%, 89.7%, 83.6%, and 91.2%, respectively. Higher Gleason's scores were associated with unfavorable BCFFS, DMFS, and OS. Pre-SRT PSA ≥0.5 ng/ml predicted worse BCFFS, LRFFS, and DMFS. In multivariate analyses, a Gleason's score of 8 to 10 was associated with decreased BCFFS (hazard ratio [HR] 3.12, 95% confidence interval [CI] 1.11-8.74, P = .031) and OS (HR 17.72, 95% CI 1.75-179.64, P = .015), and combined ADT decreased the risks of distant metastasis (HR 0.18, 95% CI 0.04-0.92, P = .039). Two patients (3.3%) experienced late grade 3 urinary toxicity. Conclusions: SRT for locoregional CR after RP achieved favorable outcomes with acceptable long-term toxicities. Higher Gleason's scores and pre-radiotherapy PSA level were unfavorable prognostic variables. Combined ADT may decrease the risks of metastases.

Affiliations

Sung Uk Lee  1 , Kwan Ho Cho  1 , Jin Ho Kim  2 , Young Seok Kim  3 , Taek-Keun Nam  4 , Jae-Sung Kim  5 , Jaeho Cho  6 , Seo Hee Choi  6 , Su Jung Shim  7 , Jin Hee Kim  8 , Ah Ram Chang  9
1 The Proton Therapy Center, Research Institute and Hospital70317National Cancer Center, Goyang, Korea.
2 65462Department of Radiation Oncology, Seoul National University Hospital, 37990Seoul National University College of Medicine, Seoul, Korea.
3 Department of Radiation Oncology, Asan Medical Center, 35029University of Ulsan College of Medicine, Seoul, Korea.
4 65722Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea.
5 Department of Radiation Oncology, Yonsei Cancer Center, 37991Yonsei University College of Medicine, Seoul, Korea.
6 46666Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea.
7 Dongsan Medical Center, 65673Keimyung University School of Medicine, Daegu, Korea.
8 Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
9 71544Department of Radiation Oncology, Soonchunhyang University Hospital, Seoul, Korea.
1 The Proton Therapy Center, Research Institute and Hospital70317National Cancer Center, Goyang, Korea.
2 65462Department of Radiation Oncology, Seoul National University Hospital, 37990Seoul National University College of Medicine, Seoul, Korea.
3 Department of Radiation Oncology, Asan Medical Center, 35029University of Ulsan College of Medicine, Seoul, Korea.
4 65722Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Hwasun, Korea.
5 Department of Radiation Oncology, Yonsei Cancer Center, 37991Yonsei University College of Medicine, Seoul, Korea.
6 46666Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea.
7 Dongsan Medical Center, 65673Keimyung University School of Medicine, Daegu, Korea.
8 Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
9 71544Department of Radiation Oncology, Soonchunhyang University Hospital, Seoul, Korea.