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Systematic review| Volume 88, ISSUE 1, P1-9, July 2008

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Adjuvant radiotherapy following radical prostatectomy for pathologic T3 or margin-positive prostate cancer: A systematic review and meta-analysis

  • Scott C. Morgan
    Affiliations
    The Ottawa Hospital Cancer Centre, Ottawa, Ont., Canada

    Division of Radiation Oncology, University of Ottawa, Ottawa, Ont., Canada
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  • Tricia S. Waldron
    Correspondence
    Corresponding author. Tricia S. Waldron, Cancer Care Ontario Program in Evidence-based Care, McMaster University, 1280 Main Street West, DTC, 3rd Floor, Hamilton, Ont., Canada L8S 4L8.
    Affiliations
    Cancer Care Ontario Program in Evidence-based Care, McMaster University, Hamilton, Ont., Canada
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  • Libni Eapen
    Affiliations
    The Ottawa Hospital Cancer Centre, Ottawa, Ont., Canada

    Division of Radiation Oncology, University of Ottawa, Ottawa, Ont., Canada
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  • Linda A. Mayhew
    Affiliations
    Cancer Care Ontario Program in Evidence-based Care, McMaster University, Hamilton, Ont., Canada
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  • Eric Winquist
    Affiliations
    London Health Sciences Centre, London, Ont., Canada

    Department of Oncology, University of Western Ontario, London, Ont., Canada
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  • Himu Lukka
    Affiliations
    Cancer Care Ontario Program in Evidence-based Care, McMaster University, Hamilton, Ont., Canada

    Juravinski Cancer Centre, Hamilton, Ont., Canada

    Department of Medicine, McMaster University, Hamilton, Ont., Canada
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  • on behalf of the Genitourinary Cancer Disease Site Group of the Cancer Care Ontario Program in Evidence-based Care
    Author Footnotes
    1 A complete list of current Genitourinary Cancer Disease Site Group Members is available at the Cancer Care Ontario web site (http://www.cancercare.on.ca).
  • Author Footnotes
    1 A complete list of current Genitourinary Cancer Disease Site Group Members is available at the Cancer Care Ontario web site (http://www.cancercare.on.ca).

      Abstract

      Background and purpose

      Results following radical prostatectomy (RP) are suboptimal in patients found to have cancer extending beyond the prostatic capsule (pT3) or present at the resection margins (R1). The optimal postoperative management of such patients is undefined. Therapeutic alternatives include adjuvant radiotherapy (RT) or active surveillance.

      Methods

      Randomized controlled trials (RCTs) were eligible for inclusion in this systematic review if they compared adjuvant RT in the immediate period after RP to active surveillance – with therapies held in reserve for salvage – in prostate cancer patients with pT3 or R1 disease or both. The primary outcome of interest was overall survival.

      Results

      Three RCTs representing 1743 patients satisfied the eligibility criteria. Two trials reported data on overall survival; a meta-analysis of the data showed no significant improvement associated with adjuvant RT (hazard ratio = 0.91, 95% CI 0.67–1.22, p = 0.52). All trials reported data on biochemical progression-free survival (bPFS). On meta-analysis, adjuvant RT significantly improved bPFS (hazard ratio = 0.47, 95% CI 0.40–0.56, p < 0.00001). One trial provided comparative graded toxicity data; there were no significant differences between arms in severe (⩾grade 3) gastrointestinal or genitourinary toxicity at five years.

      Conclusions

      To date, adjuvant RT has not been shown to improve overall survival compared with active surveillance. Longer follow-up from completed RCTs is required to accurately assess this outcome. Adjuvant RT does, however, significantly improve bPFS and is not associated with excess severe late toxicity.

      Keywords

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