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Abstract
The relationship between radiation doses and clinical relapse in patients receiving salvage radiotherapy (SRT) for biochemical recurrence (BCR) after radical prostatectomy (RP) remains unclear. We identified 292 eligible patients treated with SRT between 2005 and 2018 at 15 institutions. Clinical relapse-free survival (cRFS) between the ≥ 66 Gy (n = 226) and < 66 Gy groups (n = 66) were compared using the Log-rank test, followed by univariate and multivariate analyses and a subgroup analysis. After a median follow-up of 73 months, 6-year biochemical relapse-free survival, cRFS, cancer-specific survival, and overall survival rates were 58, 92, 98, and 94%, respectively. Six-year cRFS rates in the ≥ 66 Gy and < 66 Gy groups were 94 and 87%, respectively (p = 0.022). The multivariate analysis revealed that Gleason score ≥ 8, seminal vesicle involvement, PSA at BCR after RP ≥ 0.5 ng/ml, and a dose < 66 Gy correlated with clinical relapse (p = 0.015, 0.012, 0.024, and 0.0018, respectively). The subgroup analysis showed the consistent benefit of a dose ≥ 66 Gy in patients across most subgroups. Doses ≥ 66 Gy were found to significantly, albeit borderline, increase the risk of late grade ≥ 2 GU toxicity compared to doses < 66 Gy (14% vs. 3.2%, p = 0.055). This large multi-institutional retrospective study demonstrated that a higher SRT dose (≥ 66 Gy) resulted in superior cRFS.
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1 Nagoya City University Graduate School of Medical Sciences, Department of Radiology, Nagoya, Japan (GRID:grid.260433.0) (ISNI:0000 0001 0728 1069)
2 Kariya Toyota General Hospital, Department of Radiology, Kariya, Japan (GRID:grid.415024.6) (ISNI:0000 0004 0642 0647)
3 Department of Radiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan (GRID:grid.415024.6)
4 Japan Community Health Care Organization Chukyo Hospital, Department of Radiology, Nagoya, Japan (GRID:grid.460248.c)
5 Suzuka General Hospital, Department of Radiation Oncology, Suzuka, Japan (GRID:grid.460248.c)
6 Nagoya City West Medical Center, Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya, Japan (GRID:grid.518268.0) (ISNI:0000 0004 0568 8545)
7 Okazaki City Hospital, Department of Radiology, Okazaki, Japan (GRID:grid.413724.7)
8 Nanbu Tokushukai General Hospital, Department of Radiation Oncology, Shimajiri, Japan (GRID:grid.417339.b)
9 Nagoya City West Medical Center, Department of Radiotherapy, Nagoya, Japan (GRID:grid.518268.0) (ISNI:0000 0004 0568 8545)
10 Kasugai Municipal Hospital, Department of Radiation Oncology, Kasugai, Japan (GRID:grid.415067.1) (ISNI:0000 0004 1772 4590)
11 National Hospital Organization Nagoya Medical Center, Department of Radiation Oncology, Nagoya, Japan (GRID:grid.410840.9) (ISNI:0000 0004 0378 7902)
12 Hokuto Hospital, Department of Radiation Oncology, Obihiro, Japan (GRID:grid.452447.4) (ISNI:0000 0004 0595 9093)
13 Fujieda Heisei Memorial Hospital, Department of Radiation Oncology, Fujieda, Japan (GRID:grid.452447.4)
14 Nagoya City University Graduate School of Medical Sciences, Department of Urology, Nagoya, Japan (GRID:grid.260433.0) (ISNI:0000 0001 0728 1069)