INTRAOPERATIVE RADIOTHERAPY FOR LOCALLY ADVANCED PROSTATE CANCER: A MATCHED PAIR ANALYSIS

• Published in: Anticancer research Vol. 30; no. 4; p. 1526
• Main Authors: Mazzoleni, F, Albo, G, Rocco, B, Melegari, S, Jereczek-Fossa, BA, Detti, S, Santoro, L, Vavassori, A, Matei, D V, Orecchia, R, de Cobelli, O
• Format: Journal Article
• Language: English
• Published: 01.04.2010
• ISSN: 0250-7005

Background: The adequate treatment of locally advanced prostate cancer is still a controversial issue. In this study, we evaluated a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (LAD) and before prostatectomy (RRP). Aim: To determine whether IORT has an impact on perioperative and functional outcome compared to standard RRP. Acute and late toxicity, complications and biochemical progression free survival were also evaluated. Patients and Methods: Between June 2005 and November 2009, 38 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for LAD + IORT + RRP (Group A). IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings, further adjuvant radio- or hormonotherapy was administered. The median follow-up was 31 months. This group was retrospectively compared with a historical group of 100 patients that had undergone RRP and further adjuvant therapy selected with equivalent criteria (Group B). The comparison was conducted in a matched pair fashion. Perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as functional outcome, acute and late toxicity, rate of complications and biochemical relapse-free survival (bPFS) were evaluated and compared. Results: Baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes were higher in the IORT group (44% group A, 16% group B). The IORT group had a longer surgical time (248 min group A, 240 min group B) and catheterization (7 days group A, 6 days group B), and shorter hospital stay (6 days group A, 8 days group B). No difference in terms of continence rate was found. No major complications occurred in the groups. Acute and late toxicity were equivalent. Retrospective comparison and short follow-up seem to be major limitations. Conclusion: IORT administered before prostatectomy seems a feasible approach, with low impact on the evaluated parameters.