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Adjuvant therapy for prostate cancer
means treatment provided to patients who
treated with operation without clinical
evidence of residual disease. Adjuvant
radiation therapy is provided in the
following scenarios:
1) positive margins.
2) extra capsular extension of the tumor.
3) seminal vesicle involvement.
Three trials tested the role of adjuvant
radiation to prostate cancer patients in
randomized trials:
1) SWOG randomized patients
with PT3N0M0 prostate cancer to
postoperative radiotherapy (60-64 Gy) versus
observation. Metastasis free survival, and
overall survival (HR 0.72) were better in
the adjuvant radiation arm.
2) EORTC trial (60 Gy versus observation)
did not demonstrated survival benefit, but
there was advantage in terms of biochemical
free survival for the radiation therapy
group.
3) German trial: Eligible patients
had histologically proven adenocarcinoma of
the prostate with no known distant
metastases and a pathologic stage pT3-4 pN0
with positive or negative surgical margins,
and undetectable postoperative PSA.
randomization 60 Gy versus
observation. Biochemical
progression-free survival after 5 years in
patients with undetectable PSA after RP was
significantly improved in the RT group (72%v 54%
; P = .0015).
References:
1)
Thomspon et al. Adjuvant radiotherapy for
pathological T3N0M0 prostate cancer
significantly reduces risk of metastases and
improves survival: long-term followup of a
randomized clinical trial. J Urol.
181: 956-62 (2009).
2)
Bolla et al. Postoperative radiotherapy
after radical prostatectomy: a randomised
controlled trial (EORTC trial 22911).
Lancet. 2005 Aug
13-19;366(9485):572-8.
3)
Wiegel et al. Phase III postoperative adjuvant radiotherapy
after radical prostatectomy compared with
radical prostatectomy alone in pT3 prostate
cancer with postoperative undetectable
prostate-specific antigen: ARO 96-02/AUO AP
09/95. J Clin Oncol. 2009 Jun
20;27(18):2924-30.
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