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Radiation Oncology • Genitourinary Cancers
What dose is most appropriate when treating a post-prostatectomy patient with positive margins in the adjuvant setting?
Although the landmark randomized trials treated up to 64 Gy, there is data out of Italy suggesting that higher doses yield better biochemical control (https://www.ncbi.nlm.nih.gov/pubmed/19619960?dopt=Abstract). Can dose escalation be done safely in post-prostatectomy patients?
Answer from: Radiation Oncologist at Community Practice
The data for dose response in post RP radiation is not as robust as it is in the definitive setting. All randomised trials for adjuvant treatment used mainly 60 Gy, although retrospective data in the adjuvant setting shows better outcome with dose range from 61.5 Gy to 70 Gy. Similarly in the salvag...
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Answer from: Radiation Oncologist at Academic Institution
In our practice we offer 64 Gy at 2/fx to the prostate bed as an adjuvant dose (i.e. PSA undetectable) for the following reasons:1) This is consistent (but in the upper range) with the 3 randomized studies of adjuvant RT that give 60-64 Gy;2) In the year after prostatectomy, continence may be more s...