Abstract
Background and purpose
Three randomised trials have demonstrated the benefit of adjuvant post-prostatectomy
radiotherapy (PPRT) for high risk patients. Data also documents the effectiveness
of salvage radiotherapy following a biochemical relapse post-prostatectomy. The Radiation
Oncology Genito-Urinary Group recognised the need to develop consensus guidelines
on to whom, when and how to deliver PPRT.
Materials and methods
Draft guidelines were developed and refined at a consensus conference in June 2006
attended by 63 delegates where urological, radiotherapy and diagnostic imaging experts
spoke on aspects of PPRT. Unresolved issues were further developed by working parties
and redistributed until consensus was reached.
Results
Central to the recommendations is that patients with positive surgical margins, seminal
vesicle invasion and/or extracapsular extension have a high risk of residual local
disease and should be informed of the options of either immediate adjuvant radiotherapy
or active surveillance with early salvage in the event of biochemical recurrence.
Salvage radiotherapy should be instituted at the earliest confirmation of biochemical
recurrence. Detailed contouring guidelines have been developed, defining the regions
at risk of residual microscopic disease which should be included in the clinical target
volume. The recommended doses are 60–64 Gy for adjuvant, and 60–66 Gy for salvage radiotherapy. The role of hormone therapy in conjunction with PPRT
is yet to be defined.
Conclusions
These consensus guidelines have been developed to give clinical and technical guidance
to radiation oncologists and urologists in the management of high risk post-prostatectomy
patients.
Keywords
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Article info
Publication history
Published online: June 03, 2008
Accepted:
May 1,
2008
Received in revised form:
April 8,
2008
Received:
May 21,
2007
Identification
Copyright
© 2008 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
