Radiotherapy after Radical Prostatectomy: Treatment Recommendations Differ between Urologists and Radiation Oncologists |
| |
Authors: | Luke T Lavallée Dean Fergusson Ranjeeta Mallick Renée Grenon Scott C Morgan Franco Momoli Kelsey Witiuk Chris Morash Ilias Cagiannos Rodney H Breau |
| |
Institution: | 1. Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.; 2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; 3. Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.; 4. Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.; National University of Ireland Galway, Ireland, |
| |
Abstract: | PurposeThere is no consensus on optimal use of radiotherapy following radical prostatectomy. The purpose of this study was to describe opinions of urologists and radiation oncologists regarding adjuvant and salvage radiotherapy following radical prostatectomy.MethodsUrologists and genitourinary radiation oncologists were solicited to participate in an online survey. Respondent characteristics included demographics, training, practice setting, patient volume/experience, and access to radiotherapy. Participant practice patterns and attitudes towards use of adjuvant and salvage radiotherapy in standardized clinical scenarios were assessed.ResultsOne hundred and forty-six staff physicians participated in the survey (104 urologists and 42 genitourinary radiation oncologists). Overall, high Gleason score (Gleason 7 vs. 6, RR 1.37 95% CI 1.19-1.56, p<0.0001 and Gleason 8-10 vs. 6, RR 1.56 95% CI 1.37-1.78, p<0.0001), positive surgical margin (RR 1.43 95% CI 1.26-1.62, p<0.0001), and extraprostatic tumour extension (RR 1.16 95% CI 1.05-1.28, p<0.002) conferred an increased probability of recommending adjuvant radiotherapy. Radiation oncologists were more likely to recommend adjuvant radiotherapy across all clinical scenarios (RR 1.48, 95% CI 1.39, 1.60, p <0.001). Major differences were found for patients with Gleason 6 and isolated positive surgical margin (radiotherapy selected by 21% of urologists vs. 70% of radiation oncologists), and patients with extraprostatic extension and negative surgical margins (radiotherapy selected by 18% of urologist vs. 57% of radiation oncologists).ConclusionsUrologists and radiation oncologists frequently disagree about recommendation for post-prostatectomy adjuvant radiotherapy. Since clinical equipoise exists between adjuvant versus early salvage post-operative radiotherapy, support of clinical trials comparing these approaches is strongly encouraged. |
| |
Keywords: | |
|
|