Pf. Schellhammer et al., TREATMENT OF CLINICAL LOCAL FAILURE AFTER RADIATION-THERAPY FOR PROSTATE CARCINOMA, The Journal of urology, 150(6), 1993, pp. 1851-1855
From a base population of 634 patients with prostate cancer treated by
external beam therapy with a median followup of 8 years and 123 patie
nts treated by interstitial brachytherapy with iodine-125 (I-125) isot
ope with a median followup of 13 years, those with local failure only
were identified. There were 57 external beam radiotherapy (9%) and 15
I-125 (12%) treated patients with local failure only among the base po
pulation. All but 3 patients (2 given external beam radiotherapy and 1
given I-125) were treated with hormonal manipulation without extirpat
ive surgery. The overall cancer-specific median survival with hormonal
therapy from the date of local failure was 70 months for 55 patients
treated by external beam radiotherapy and 87 months for 14 treated by
I-125. Patients with low grade, small volume tumors most likely to ben
efit from salvage surgery are also those who will experience prolonged
survival with hormonal therapy. Patients with local failure only trea
ted by hormonal manipulation had statistically longer cancer-specific
survival rates from the date of failure than did similarly treated pat
ients experiencing distant failure with local failure. This finding su
ggests a difference in the biological aggressiveness between tumors as
sociated with distant and local failure versus local failure only. To
select the patients with local failure only who would be candidates fo
r and potentially benefited by salvage surgery, those with pretreatmen
t stage A or B disease who were less than 72 years old were identified
. A total of 17 patients treated by external beam radiotherapy and 7 t
reated by I-125 fulfilled these criteria. Therefore, as determined by
local failure only, patient age and pre-radiation clinical stage, only
2 to 5% of the patients treated with radiation modalities are ultimat
ely optimal candidates for salvage surgery.