Intraoperative radiotherapy during radical prostatectomy for intermediate-risk to locally advanced prostate cancer: Treatment technique and evaluation of perioperative and functional outcome vs standard radical prostatectomy, in a matched-pair analysis

Bernardo Rocco, Barbara A. Jereczek-Fossa, Deliu Victor Matei, Fabrizio Verweij, Luigi Santoro, Andrea Vavassori, Juan Camillo Ospina, Francisco Cedeira, Mario Ciocca, Roberto Orecchia, Ottavio De Cobelli

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Abstract

Objective To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue. Patients and methods Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared. Results The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations. Conclusions IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated.

Original languageEnglish
Pages (from-to)1624-1630
Number of pages7
JournalBJU International
Volume104
Issue number11
DOIs
Publication statusPublished - Dec 2009

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Matched-Pair Analysis
Prostatectomy
Prostatic Neoplasms
Radiotherapy
Disease-Free Survival
Lymph Node Excision
Catheterization
Therapeutics
Particle Accelerators
Operating Rooms
Operative Time
Radio
Blood Transfusion
Drainage
Length of Stay
Hospitalization
Lymph Nodes
Hormones
Electrons

Keywords

  • Continence
  • Intraoperative radiotherapy
  • Prostate cancer
  • Prostatectomy
  • Toxicity

ASJC Scopus subject areas

  • Urology

Cite this

@article{e7b7bee5634d4c0faefe0110a5d7d8bd,
title = "Intraoperative radiotherapy during radical prostatectomy for intermediate-risk to locally advanced prostate cancer: Treatment technique and evaluation of perioperative and functional outcome vs standard radical prostatectomy, in a matched-pair analysis",
abstract = "Objective To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue. Patients and methods Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90{\%} isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared. Results The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations. Conclusions IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated.",
keywords = "Continence, Intraoperative radiotherapy, Prostate cancer, Prostatectomy, Toxicity",
author = "Bernardo Rocco and Jereczek-Fossa, {Barbara A.} and Matei, {Deliu Victor} and Fabrizio Verweij and Luigi Santoro and Andrea Vavassori and Ospina, {Juan Camillo} and Francisco Cedeira and Mario Ciocca and Roberto Orecchia and {De Cobelli}, Ottavio",
year = "2009",
month = "12",
doi = "10.1111/j.1464-410X.2009.08668.x",
language = "English",
volume = "104",
pages = "1624--1630",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "11",

}

TY - JOUR

T1 - Intraoperative radiotherapy during radical prostatectomy for intermediate-risk to locally advanced prostate cancer

T2 - Treatment technique and evaluation of perioperative and functional outcome vs standard radical prostatectomy, in a matched-pair analysis

AU - Rocco, Bernardo

AU - Jereczek-Fossa, Barbara A.

AU - Matei, Deliu Victor

AU - Verweij, Fabrizio

AU - Santoro, Luigi

AU - Vavassori, Andrea

AU - Ospina, Juan Camillo

AU - Cedeira, Francisco

AU - Ciocca, Mario

AU - Orecchia, Roberto

AU - De Cobelli, Ottavio

PY - 2009/12

Y1 - 2009/12

N2 - Objective To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue. Patients and methods Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared. Results The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations. Conclusions IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated.

AB - Objective To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue. Patients and methods Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared. Results The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations. Conclusions IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated.

KW - Continence

KW - Intraoperative radiotherapy

KW - Prostate cancer

KW - Prostatectomy

KW - Toxicity

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U2 - 10.1111/j.1464-410X.2009.08668.x

DO - 10.1111/j.1464-410X.2009.08668.x

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AN - SCOPUS:70449362038

VL - 104

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JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 11

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