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Early salvage radia...
Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy.
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- Cortés-González, Jeff R (author)
- Karolinska Institutet
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- CARLSSON, STEFAN, 1987 (author)
- Karolinska Institutet
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Sandberg, Katinka (author)
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Eriksson, Marie-Hjelm (author)
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- Wiklund, Peter (author)
- Karolinska Institutet
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Carlsson, Stefan (author)
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- Cohn-Cedermark, Gabriella (author)
- Karolinska Institutet
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Harmenberg, Ulrika (author)
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- Gustafsson, Ove (author)
- Karolinska Institutet
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Levitt, Seymour H (author)
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- Lennernäs, Bo, 1963 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för onkologi,Institute of Clinical Sciences, Department of Oncology,University of Gothenburg
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- Brandberg, Yvonne (author)
- Karolinska Institutet
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- Márquez, Marcela (author)
- Karolinska Institutet
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Kälkner, Karl-Mikael (author)
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Nilsson, Sten (author)
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(creator_code:org_t)
- 2012-11-13
- 2013
- English.
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In: International journal of oncology. - : Spandidos Publications. - 1791-2423 .- 1019-6439. ; 42:1, s. 109-17
- Related links:
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http://dx.doi.org/10...
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https://gup.ub.gu.se...
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Abstract
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- The aim of this study was to investigate the role of 70Gy salvage radiotherapy (SRT) combined with short-term neoadjuvant hormonal therapy (NHT) in the treatment of recurrent disease after radical prostatectomy (RP), and to consider quality of life (QoL), survival outcomes and impact of co-morbidities on treatment-related rectal-genitourinary toxicity. Electronic records of 184 SRT patients treated consecutively between October 2001 and February 2007 were analyzed. Median age was 64 years (median follow-up 48months). NHT was given to 165 patients (median 3 months). Pre-RP and pre-SRT PSA, PSA doubling time, Gleason score (GS), seminal vesicle invasion (SVI) and detectable post-SRT PSA were recorded. Any detectable PSA or PSA >0.1 ng/ml + nadir was considered biochemical failure (BcF). The Charlson co-morbidity index was used to correlate co-morbidities and rectal-genitourinary toxicity. Scores from the health-related QoL EORTC QLQ-C30 and PR-25 questionnaires were also evaluated. In 116 (63%) patients, a long-lasting curative effect was indicated by undetectable PSA levels. In univariate analysis, using BcF as an outcome variable, p<0.001 was found for GS, pre-SRT PSA, SVI and detectable post-SRT PSA. Multivariate analysis showed p=0.01 for SVI, p=0.09 for GS, and detectable post-SRT PSA (p=0.01); with metastases as an outcome variable, only SVI was significant (p=0.007). Cancer-specific and overall survival were 99 and 95%, respectively. Although microscopy showed SVI or GS 8-10 in the prostatectomy specimens 17/40(43%) and 13/29 (45%), respectively, of patients still showed undetectable PSA at long-term follow-up (median 55 months) after SRT. Likewise, 11/31 (36%) patients with pre-SRT PSA >1.0 ng/ml and 80/134 (60%) patients with PSA doubling time (PSADT) <10 still showed undetectable PSA after 50 months. Slightly elevated acute and late rectal-genitourinary grade 3-4 toxicity was observed. No association with co-morbidity/toxicity was found. EORTC QLQ-C30 scores were similar to or slightly better than reference values. SRT with 70 Gy combined with 3-month NHT results in long-term undetectable PSA in >50% of patients with recurrence after RP with acceptable rectal-genitourinary toxicity and without negatively affecting long-term QoL. Non-metastatic patients should not be disqualified from receiving SRT although presenting with poor prognostic factors at surgery.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- SAMHÄLLSVETENSKAP -- Psykologi -- Tillämpad psykologi (hsv//swe)
- SOCIAL SCIENCES -- Psychology -- Applied Psychology (hsv//eng)
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Cortés-González, ...
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CARLSSON, STEFAN ...
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Sandberg, Katink ...
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Eriksson, Marie- ...
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Wiklund, Peter
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Carlsson, Stefan
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Cohn-Cedermark, ...
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Harmenberg, Ulri ...
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Gustafsson, Ove
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Levitt, Seymour ...
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Lennernäs, Bo, 1 ...
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Brandberg, Yvonn ...
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Márquez, Marcela
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Kälkner, Karl-Mi ...
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Nilsson, Sten
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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SOCIAL SCIENCES
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University of Gothenburg
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Chalmers University of Technology
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Karolinska Institutet