Ten year outcomes of moderately hypofractionated salvage post prostatectomy radiotherapy and external validation of a contemporary multivariable nomogram for biochemical failure
Logue, John P
Wylie, James P
AffiliationDepartment of Clinical Oncology, The Christie NHS Foundation Trust, Manchester
MetadataShow full item record
AbstractPURPOSE: Although there is high level evidence supporting moderately hypofractionated radiotherapy for definitive prostate treatment, there is less evidence for its use in the post prostatectomy setting. We externally validated a contemporary nomogram predicting biochemical failure (BF) after salvage radiotherapy (SRT) and report long term disease control outcomes for hypofractionated SRT to the prostate bed. METHODS AND MATERIALS: A retrospective review was performed for 112 patients treated with hypofractionated SRT (52.5Gy/20 fractions using 3D conformal radiotherapy) for pT2-4R0-1N0/XM0 prostate adenocarcinoma, with post-operative PSA greater than 0.1ng/mL or rising. Freedom from biochemical failure (FFBF), distant metastasis (DM), cancer specific mortality (CSM) and overall survival (OS) were analysed from commencement of radiotherapy. Cox regression was performed on FFBF to account for covariates. BF was defined as a PSA ?0.4 ng/mL and rising after SRT. Early SRT was defined as SRT commencing at a pre-SRT PSA of ?0.2 ng/mL. RESULTS: Median follow up was 10.0 years (interquartile range 9.3-10.7 years), median pre-SRT PSA was 0.4 ng/mL and ADT was used in 14% of patients. Five/ten year FFBF, DM, CSM and OS was 68%/51%, 7%/16%, 5%/11%, and 90%/75%. FFBF for early SRT compared to late SRT was 81% vs 66% at five years and 68% vs 49% at ten years. On multivariable analysis, pre-SRT PSA, ISUP grade group, SVI, and ADT use were associated with FFBF. The nomogram c-index was 0.67, and it overestimated FFBF by 10/15% at five/ten years, with confidence intervals overlapping the line of unity. CONCLUSION: Hypofractionated SRT provides long term disease control outcomes comparable to conventionally fractionated radiotherapy. Early SRT provides improved disease control, with two thirds of patients with pre-SRT PSA of ?0.2 ng/mL being free of BF at 10 years. We performed the first external validation of the Tendulkar salvage nomogram which showed a robust model performance.
CitationChin S, Fatimilehin A, Walshaw R, Argarwal A, Mistry H, Elliott T, et al. Ten year outcomes of moderately hypofractionated salvage post prostatectomy radiotherapy and external validation of a contemporary multivariable nomogram for biochemical failure. Int J Radiat Oncol Biol Phys. 2020.
JournalInternational Journal of Radiation Oncology Biology Physics
- Contemporary Update of a Multi-Institutional Predictive Nomogram for Salvage Radiotherapy After Radical Prostatectomy.
- Authors: Tendulkar RD, Agrawal S, Gao T, Efstathiou JA, Pisansky TM, Michalski JM, Koontz BF, Hamstra DA, Feng FY, Liauw SL, Abramowitz MC, Pollack A, Anscher MS, Moghanaki D, Den RB, Stephans KL, Zietman AL, Lee WR, Kattan MW, Stephenson AJ
- Issue date: 2016 Oct 20
- Multi-institutional Evaluation of Elective Nodal Irradiation and/or Androgen Deprivation Therapy with Postprostatectomy Salvage Radiotherapy for Prostate Cancer.
- Authors: Ramey SJ, Agrawal S, Abramowitz MC, Moghanaki D, Pisansky TM, Efstathiou JA, Michalski JM, Spratt DE, Hearn JWD, Koontz BF, Liauw SL, Pollack A, Anscher MS, Den RB, Stephans KL, Zietman AL, Lee WR, Stephenson AJ, Tendulkar RD
- Issue date: 2018 Jul
- A comprehensive assessment of the prognostic utility of the Stephenson nomogram for salvage radiation therapy postprostatectomy.
- Authors: Johnson S, Jackson W, Speers C, Feng F, Hamstra D
- Issue date: 2014 Nov-Dec
- Long-term outcomes after high-dose postprostatectomy salvage radiation treatment.
- Authors: Goenka A, Magsanoc JM, Pei X, Schechter M, Kollmeier M, Cox B, Scardino PT, Eastham JA, Zelefsky MJ
- Issue date: 2012 Sep 1
- Prostate-specific antigen after salvage radiotherapy for postprostatectomy biochemical recurrence predicts long-term outcome including overall survival.
- Authors: Bartkowiak D, Thamm R, Bottke D, Siegmann A, Böhmer D, Budach V, Wiegel T
- Issue date: 2018 Mar