High-dose 3D-CRT in the radical and postoperative setting for prostate cancer. Analysis of survival and late rectal and urinary toxicity

Purpose. The aim of the study was to retrospectively compare outcome and complications of prostate cancer patients treated with a curative and postoperative intent using a pretreatment defined NCCN classification. Material and methods. A total of 103 patients was treated curatively (RAD) and 94 postoperatively (POST-OP). The mean age was higher in the RAD group (72.6 years; range, 56.4-85.1) than in the POST-OP group (65.4 years; range, 43.9-77) (P <0.0001). According to the NCCN prognostic classification, 13 (12%) patients were at low risk, 48 (47%) at intermediate risk and 42 (41%) at high risk in the RAD group. In the POST-OP group, 13 (14%) patients were low risk, 37 (40%) at intermediate risk and 44 (46%) at high risk. Hormone therapy was used in 98 patients (95%) in the RAD group and 45 patients (47.8%) in the POST-OP group. Patients were treated with three-dimensional conformal radiotherapy. The prescription dose was 80 Gy in 2-Gy fractions in the RAD group and 70 Gy in 2-Gy fractions in the POST-OP. Results. No biochemical, clinical relapse was found in low-risk patients in the RAD group and 1 relapse was found in the POST-OP group. The largest number of relapses occurred (39%) and (33%) in intermediate-high risk in RAD and POST-OP groups, respectively. In the cause-specific survival analysis, no significant differences were found in the high-risk group between RAD and POST-OP groups (P = 0.9). In the analysis of 5-year biochemical relapse-free survival, no significant differences were found in the high-risk group between RAD and POST-OP groups (P = 0.1020). Conclusions. Radiotherapy in the RAD low-risk group was an excellent treatment. RAD and POST-OP radiotherapy were well tolerated with very low toxicity. The cause-specific survival at 5 years was 95% and 97% for the two treatment groups, RAD and POST-OP, respectively (logrank test, P = 0.2908).