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Does Postoperative Radiation Therapy Benefit Patients With Prostate Cancer?

National Cancer Institute, Rockville, MD

To the Editor:

Van der Kwast et al¹ studied the effect of radiotherapy after prostatectomy in patients with adverse risk factors. The authors stated in the Discussion, "Our subset analysis showed that adjuvant radiotherapy reduces the risk of biochemical recurrence specifically in those with positive surgical margins."

However, they stated in the Trial Design that the primary trial end point (biochemical progression-free survival) included "the start of treatment in the absence of progression." That has profound implications for any conclusions that may be drawn from the study.

Patients with positive margins commonly begin androgen deprivation therapy immediately, before evidence of biochemical and clinical failure. The authors counted this common practice as events rather than protocol violations in the study.

Therefore, instead of suggesting that adjuvant radiotherapy reduces the risk of biochemical recurrence in those with positive surgical margins, a more plausible conclusion of this study is as follows: "Patients with positive margins (especially if forbidden by protocol to receive radiotherapy) are more likely to receive androgen deprivation therapy without biochemical or clinical failure"—not a very enlightening finding.

AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

ACKNOWLEDGMENTS

The views expressed herein are those of the author and do not necessarily represent the views of the National Institutes of Health or the US Government.

REFERENCES

1. Van der Kwast TH, Bolla M, Van Poppel H, et al: Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911. J Clin Oncol 25:4178-4186, 2007[Abstract/Free Full Text]

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• In Reply:
  Theodorus H. van der Kwast, Laurence Collette, and Michel Bolla
  JCO 2008 26: 1392-1393 [Full Text]

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