Are all prostate cancer patients "fit" for salvage radiotherapy?

Table 1 Constraints recommended in salvage radiotherapy with conventional fractionation

Organ at risk	Constraints
Bladder	V70 < 30%
	V55 < 50%
Rectum	V70 < 20%
	V65 < 25%
	V60 < 35%
	V50 < 50%
Femoral heads	V50 ≤ 10%
	Dmax < 45 Gy
Small bowel	V55 < 5 mL
	V15 < 120 mL

Quantitative analysis of normal tissue effects in the clinic.

Table 2 Risk groups for salvage radiotherapy

Risk group	Factors
Low-risk	PSA < 0.6 ng
	PSA-DT > 12 mo
	Gleason score ≤ 7 (ISUP 1,2)
	pT2 pN0
	IBR > 18 mo
	Negative margins
Intermediate risk	PSA = 0.6 to < 1 ng
	PSA-DT 6-12 mo
	Gleason score 7 (ISUP 3)
	pT2-T3a pN0 or pNx
	IBR > 18 mo
	Positive margins
High-risk	PSA ≥ 1 ng
	PSA-DT < 6 mo
	Gleason score 8-10 (ISUP 4,5)
	pT3b pN0 or pNx
	IBR < 18 mo
	Positive margins

ADT: Androgen deprivation therapy; PSA: Prostate-specific antigen; PSA-DT: Prostate-specific antigen doubling time; IBR: Interval to biochemical recurrence; ISUP: International Society of Urological Patheology.

Table 3 Exclusion criteria in postoperative radiotherapy phase 3 trials

Postoperative radiotherapy	Trial	Exclusion criteria
Adjuvant RT	EORTC 22911	> 75 yr old
		WHO PS > 1
		PSA > 0.3 ng/mL
	ARO 96-02/AUOAP 09/95	> 75 yr old
		WHO PS > 1
		Detectable PSA
	SWOG 8794	WHO PS > 2
		Total urinary incontinence
		Pelvic infection or urinary extravasation
		Intraoperative rectal injury
Salvage RT ± ADT	RTOG 9601	Life expectancy < 10 yr
		I. Karnofsky < 80%
		Evidence of hepatic disease
		PSA > 4 ng/mL
	GETUG-AFU-16	WHO PS > 1
		Life expectancy < 10 yr
		Inadequate cardiac function
		Another invasive cancer
		PSA > 2 ng/mL
Salvage vs adjuvant RT ± ADT	RAVES 08.03	WHO PS > 1
		Concurrent cytotoxic medication
		Hip prosthesis
		Co-morbidities that would interfere with treatment or 5-yr follow-up
		PSA > 0.10 ng/mL
	RADICALS	Other active malignancy
		PSA > 0.20 ng/mL
	PAC GETUG	WHO PS > 1
		Other active malignancy
		Life expectancy < 10 yr
		PSA > 0.10 ng/mL
		Severe and uncontrolled arterial hypertension

ADT: Androgen-deprivation therapy; PSA: Prostate-specific antigen; PS: Performance status; WHO: World Health Organization; RT: Radiotherapy.