ASCO endorses adjuvant/salvage RT guideline

The American Society of Clinical Oncology has endorsed the AUA/American Society for Radiation Oncology guideline on the use of adjuvant and salvage radiotherapy after prostatectomy.

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The Adjuvant and Salvage Radiotherapy After Prostatectomy: ASTRO/AUA Guideline was released jointly by the AUA and ASTRO in 2013. ASCO included a qualifying statement about radiotherapy candidates and their risk of recurrence and disease progression. Among the guideline’s recommendations:

• Physicians should offer adjuvant radiotherapy to patients who have adverse pathologic findings at prostatectomy (ie, seminal vesicle invasion, extensive positive surgical margins) and offer salvage radiotherapy to patients with detectable postoperative PSA or local recurrence after prostatectomy.

• Patients should be informed that, while adjuvant radiotherapy reduces the risk of recurrence and disease progression, its impact on preventing metastases and extending survival is less clear.

• The decision to administer radiotherapy should be made by the patient and the multidisciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status.

The guideline is a comprehensive review of 324 research articles of English-language publications published from Jan. 1, 1990 through Dec. 15, 2012. An ASCO guideline endorsement panel determined that the guideline recommendations, published in the Journal of Urology (2013; 190:441-9) and the International Journal of Radiation Oncology • Biology • Physics (2013; 86:822-8), are “clear, thorough, and based on the most relevant scientific evidence,” ASCO said in a press release.

ASCO added one qualifying statement that not all men who are candidates for adjuvant or salvage radiotherapy have the same risk of recurrence or disease progression, and thus, not all men will derive the same benefit from adjuvant radiotherapy. Those at the highest risk for recurrence after radical prostatectomy (including men with seminal vesicle invasion, Gleason score 8 to 10, extensive positive margins, and detectable postoperative PSA) are likely to derive the greatest benefit, ASCO said.

The endorsement was published online in the Journal of Clinical Oncology (Nov. 2, 2014).

Resources for clinicians and patients include:

• podcast for patients with guideline endorsement co-chair Howard Sandler, MD, MS, available at http://www.cancer.net/blog/2014-11/new-endorsement-asco-radiation-treatment-after-prostatectomy

• the guideline itself, available at http://www.asco.org/quality-guidelines/adjuvant-and-salvage-radiotherapy-after-prostatectomy-american-society-clinical, along with supplementary materials.

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