SAN FRANCISCO—Hypofractionated radiotherapy (65 Gy in 2.5-Gy fractions) appears to be a convenient, safe, and efficacious approach to salvage therapy after radical prostatectomy, according to researchers from the University of Wisconsin. Looking at 108 men, investigators found that biochemical failure (increasing prostate-specific antigen levels) compared favorably with other studies. They presented their findings at the 2010 Genitourinary Cancers Symposium.

Approximately 25% of men experience biochemical failure following prostatectomy, so early salvage therapy may be a suitable alternative to the adjuvant treatment of patients at higher risk for failure. Other studies have suggested that hypofractionation is well-tolerated and efficacious in the definitive setting but experience in the salvage setting has been limited. It is theorized that hypofractionation may improve efficiency, reduce costs, and provide patient benefits in this population.

For the current study, researchers conducted a retrospective analysis of 108 men (mean age, 63 years) treated to the prostatic fossa with 65 Gy in 26 fractions of 2.5 Gy. The median follow-up was 32.4 months (range, 5.8-70.5). A total of 18 (17%) patients had androgen-deprivation therapy following surgery or concurrently with radiation (maximum duration of 2 months after salvage).

The researchers found that the actuarial freedom from biochemical failure at 4 years was 67%. They also found that only two biochemical failures occurred later than 24 months. The investigators found only one acute grade 3 genitourinary toxicity (obstruction) in a patient previously treated for bladder neck contracture.

“We found it is very safe, and the level of side effects was very low. The level of side effects is consistent with or lower than what people have found with more standard and longer course radiation therapy. Secondly, it also appears to be very effective. We found that almost 70% of the patients longterm have reestablished control of their tumors,” said study investigator Mark Ritter, MD, who is a professor of human oncology at the University of Wisconsin School of Medicine and Public Health, Madison in an interview with the Journal of Multidisciplinary Cancer Care.

He said that approach is much more convenient for the patients and a more efficient use of equipment. He said it could prove to be a boon to patients and medical facilities if they adopted this regimen on a wide scale. Lead study investigator Tim Kruser, MD, an oncology resident at the University of Wisconsin, said these findings are very good news for men who have radical prostatectomies. He said patients would like to have their treatment in a quicker fashion. “It means fewer patient visits, it would be cheaper overall, and the side effects are similar to more traditional regimens,” said Kruser.