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PLoS One. 2014 Aug 14;9(8):e104918. doi: 10.1371/journal.pone.0104918. eCollection 2014.

Adjuvant and salvage radiotherapy after prostatectomy: a systematic review and meta-analysis.

Author information

1
Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
2
Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, China.
3
Department of Oncology, Sun Yat-sen Memorial Hospital, Guangzhou, China.
4
Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.

Abstract

PURPOSE:

In men with adverse prognostic factors (APFs) after radical prostatectomy (RP), the most appropriate timing to administer radiotherapy remains a subject for debate. We conducted a systemic review and meta-analysis to evaluate the therapeutic strategies: adjuvant radiotherapy (ART) and salvage radiotherapy (SRT).

MATERIALS AND METHODS:

We comprehensively searched PubMed, EMBASE, Web of Science and the Cochrane Library and performed the meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the prognostic factors of ART and SRT.

RESULTS:

Between May 1998 and July 2012, 2 matched control studies and 16 retrospective studies including a total of 2629 cases were identified (1404 cases for ART and 1185 cases for SRT). 5-year biochemical failure free survival (BFFS) for ART was longer than that for SRT (Hazard Ratio [HR]: 0.37; 95% CI, 0.30-0.46; p<0.00001, I(2) = 0%). 3-year BFFS was significantly longer in the ART (HR: 0.38; 95% CI, 0.28-0.52; p<0.00001, I(2) = 0%). Overall survival (OS) was also better in the ART (RR: 0.53; 95% CI, 0.41-0.68; p<0.00001, I(2) = 0%), as did disease free survival (DFS) (RR: 0.53; 95% CI, 0.43-0.66; p<0.00001, I(2)  = 0%). Exploratory subgroup analysis and sensitivity analysis revealed the similar results with original analysis.

CONCLUSION:

ART therapy offers a safe and efficient alternative to SRT with longer 3-year and 5-year BFFS, better OS and DFS. Our recommendation is to suggest ART for patients with APFs and may reduce the need for SRT. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update this analysis.

PMID:
25121769
PMCID:
PMC4133270
DOI:
10.1371/journal.pone.0104918
[Indexed for MEDLINE]
Free PMC Article
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