Open AccessAre all prostate cancer patients "fit" for salvage radiotherapy?
Author(s) -
Carmen GonzálezSan Segundo,
A. Gómez-Iturriaga,
Felipe Couñago
Publication year - 2020
Publication title -
world journal of clinical oncology
Language(s) - English
Resource type - Journals
ISSN - 2218-4333
DOI - 10.5306/wjco.v11.i1.1
Subject(s) - medicine , prostate cancer , radiation therapy , androgen deprivation therapy , stage (stratigraphy) , salvage therapy , adjuvant , oncology , prostate specific antigen , adjuvant radiotherapy , prostatectomy , biochemical recurrence , cancer , surgery , chemotherapy , paleontology , biology
The indication for salvage radiotherapy (RT) (SRT) in patients with biochemically-recurrent prostate cancer after surgery is based on prostate-specific antigen (PSA) levels at the time of biochemical recurrence. Although there are clear criteria (pT3-pT4 disease and/or positive margins) for the use of adjuvant radiotherapy, no specific clinical or tumour-related criteria have yet been defined for SRT. In retrospective series, 5-year biochemical progression-free survival (PFS) ranges from 35%-85%, depending on the PSA level at the start of RT. Two phase 3 trials have compared SRT with and without androgen deprivation therapy (ADT), finding that combined treatment (SRT+ADT) improves both PFS and overall survival. Similar to adjuvant RT, the indication for ADT is based on tumour-related factors such as PSA levels, tumour stage, and surgical margins. The number of patients referred to radiation oncology departments for SRT continues to rise. In the present article, we define the clinical, therapeutic, and tumour-related factors that we believe should be evaluated before prescribing SRT. In addition, we propose a decision algorithm to determine whether the patient is fit for SRT. This algorithm will help to identify patients in whom radiotherapy is likely to improve survival without significantly worsening quality of life.