Improved toxicity profile following high-dose postprostatectomy salvage radiation therapy with intensity-modulated radiation therapy

Eur Urol. 2011 Dec;60(6):1142-8. doi: 10.1016/j.eururo.2011.08.006. Epub 2011 Aug 12.


Background: With salvage radiation therapy (SRT) in the postprostatectomy setting, the need to deliver sufficient radiation doses to achieve a high probability of tumor control is balanced with the risk of increased toxicity. Intensity-modulated radiation therapy (IMRT) in the postprostatectomy salvage setting is gaining interest as a treatment strategy.

Objective: Compare acute and late toxicities in patients treated with IMRT and three-dimensional conformal radiation therapy (3D-CRT) in the postprostatectomy salvage setting.

Design, setting, and participants: A total of 285 patients who were treated at our institution between 1988 and 2007 with SRT after radical prostatectomy for biochemical recurrence were identified. All medical records were reviewed and toxicity recorded. Median follow-up was 60 mo.

Intervention: All patients were treated with SRT with either 3D-CRT (n=109) or IMRT (n=176). A total of 205 patients (72%) were treated with doses ≥70Gy.

Measurements: Late gastrointestinal (GI) and genitourinary (GU) toxicities were recorded using the Common Terminology Criteria for Adverse Events v. 3.0 definition.

Results and limitations: The 5-yr actuarial rates of late grade ≥2 GI and GU toxicity were 5.2% and 17.0%, respectively. IMRT was independently associated with a reduction in grade ≥2 GI toxicity compared with 3D-CRT (5-yr IMRT, 1.9%; 5-yr 3D-CRT, 10.2%; p=0.02). IMRT was not associated with a reduction in risk of grade ≥2 GU toxicity (5-yr IMRT, 16.8%; 5-yr 3D-CRT, 15.8%; p=0.86), urinary incontinence (5-yr IMRT, 13.6%; 5-yr 3D-CRT, 7.9%; p=0.25), or grade 3 erectile dysfunction (5-yr IMRT, 26%; 5-yr 3D-CRT, 30%; p=0.82). Of patients who developed late grade ≥2 GI or GU toxicity, 38% and 44%, respectively, experienced resolution of their symptoms prior to the last follow-up.

Conclusions: Our experience with high-dose IMRT in the postprostatectomy salvage setting demonstrates that the treatment can be delivered safely with an associated reduction in late GI toxicity.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Disease-Free Survival
  • Gastrointestinal Diseases / etiology
  • Gastrointestinal Diseases / prevention & control
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Male Urogenital Diseases / etiology
  • Male Urogenital Diseases / prevention & control
  • Middle Aged
  • Neoplasm Recurrence, Local*
  • New York City
  • Prostate-Specific Antigen / blood
  • Prostatectomy*
  • Prostatic Neoplasms / immunology
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / radiotherapy*
  • Prostatic Neoplasms / secondary
  • Prostatic Neoplasms / surgery*
  • Radiation Dosage
  • Radiation Injuries / etiology
  • Radiation Injuries / mortality
  • Radiation Injuries / prevention & control*
  • Radiotherapy, Adjuvant
  • Radiotherapy, Conformal / adverse effects*
  • Radiotherapy, Conformal / mortality
  • Radiotherapy, Intensity-Modulated / adverse effects*
  • Radiotherapy, Intensity-Modulated / mortality
  • Regression Analysis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Salvage Therapy / adverse effects*
  • Salvage Therapy / mortality
  • Time Factors
  • Treatment Outcome


  • Prostate-Specific Antigen