Between 10 and 40% of patients who have undergone a radical prostatectomy may have a biologic recurrence. Local or distant failure represents the possible patterns of relapse. Patients at high-risk for local relapse have extraprostatic disease, positive surgical margins or seminal vesicles infiltration or high Gleason score at pathology. Three phase-III randomized clinical trials have shown that, for these patients, adjuvant irradiation reduces the risk of tumoral progression without higher toxicity. Salvage radiotherapy for late relapse allows a disease control in 60-70% of the cases. Several research in order to improve the therapeutic ratio of the radiotherapy after prostatectomy are evaluate in the French Groupe d'Étude des Tumeurs Urogénitales (Gétug) and of the French association of urology (Afu). The Gétug-Afu 17 trial will provide answers to the question of the optimal moment for postoperative radiotherapy for pT3-4 R1 pN0 Nx patients, with the objective of comparing an immediate treatment to a differed early treatment initiated at biological recurrence. The Gétug-Afu 22 questions the place of a short hormonetherapy combined with image-guided, intensity-modulated radiotherapy (IMRT) in adjuvant situation for a detectable prostate specific antigen (PSA). The implementation of a multicenter quality control within the Gétug-Afu in order to harmonize a modern postoperative radiotherapy will allow the development of a dose escalation IMRT after surgery.
Written by:
Guérif S,1 Latorzeff I,2 Lagrange JL,3 Hennequin C,4 Supiot S,5 Garcia A,6 François P,6 Soulié M,7 Richaud P,8 Salomon L9 Are you the author?
1Service de radiothérapie, pôle régional de cancérologie, CHU de Poitiers, 350, avenue Jacques-Cœur, 86000 Poitiers, France. Electronic address: .
2Service de radiothérapie, groupe Oncorad Garonne, clinique Pasteur, « L'Atrium », 1, rue de la Petite-Vitesse, 31300 Toulouse, France.
3Service de radiothérapie, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
4Service de radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefeaux, 75475 Paris cedex, France.
5Service de radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France.
6UF radiophysique, pôle régional de cancérologie, CHU de Poitiers, 350, avenue Jacques-Cœur, 86000 Poitiers, France.
7Service d'urologie, CHU Rangueil, 1, avenue du Pr-Jean-Poulhès, 31400 Toulouse, France.
8Service de radiothérapie, centre régional de lutte contre le cancer, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France.
9Service d'urologie, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
Article in French
Reference: Cancer Radiother. 2014 Oct;18(5-6):517-23.
doi: 10.1016/j.canrad.2014.07.149
PubMed AbstractPubMed Abstract
PMID: 25195116