Late toxicity after postprostatectomy salvage radiation therapy

Abstract 

Purpose

To evaluate late toxicity in patients who received salvage external beam radiotherapy (EBRT) for a detectable prostate-specific antigen (PSA) level after radical prostatectomy (RP).

Methods

A cohort of 308 consecutive patients underwent salvage EBRT from July 1987 through June 2003 for a detectable PSA level after RP. All were treated with high-energy photons (6–20MV) to a median dose of 64.8Gy (range: 54.0–72.4Gy) in 1.8- to 2.0-Gy fractions.

Results

Median follow-up from the completion of EBRT was 60months (range: 1day–174months). Late toxicity occurring more than 90days after EBRT completion was identified in 41 patients (13%). Twelve patients (3.9%) had grade 2 urethral strictures and were treated with urethral dilation, 3 patients had grade 3 cystitis, and 1 had a grade 4 rectal complication. These numbers correspond to an estimated 0.7% (95% confidence interval, 0.0–1.6%) of patients experiencing a grade 3 or 4 complication by 5years after the start of EBRT.

Conclusions

Salvage EBRT for a detectable PSA level after RP is the only curative treatment in this setting. This treatment can be administered in a manner that results in a low likelihood of late complications.

Abbreviations: CI, confidence interval, EBRT, external beam radiotherapy, EORTC, European Organisation for Research and Treatment of Cancer, PSA, prostate-specific antigen, RP, radical prostatectomy

Keywords: Adjuvant therapy, Prostate-specific antigen, Radiotherapy