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Adjuvant and salvage radiation therapy after prostatectomy: investigating beliefs and practices of radiation oncologists.

OBJECTIVE
Evidence regarding adjuvant radiation therapy (ART) and salvage radiation therapy (SRT) following radical prostatectomy (RP) for prostate cancer is inconsistent. The study objectives were to collect survey information on Italian radiation oncologists' (RO) beliefs regarding the use of ART and SRT following RP and to compare the results of Italian RO with those of American RO available from an analogous survey.


METHODS
A modified version of a US-based questionnaire captured attitudes and clinical approaches regarding post-RP RT of all 716 RO practicing in 147 radiation oncology centres in Italy. Bivariate analyses compared the responses of Italian RO with those of American RO retrieved from a previously published study.


RESULTS
Analysable questionnaires were completed by 153 Italian RO (response rate, 21%). Variations in practice were found for RT use, timing, dosage and technique. All Italian RO supported ART use, although factors influencing the decision to initiate ART varied. Most RO (81%) would wait 3-6 months after surgery before beginning RT. Compared with Italian RO, more American RO believed ART improves survival outcomes (70% vs 35%, p < 0.001), would initiate ART based solely on adverse pathological features (79% vs 69%, p < 0.001) and would initiate SRT based on any detectable prostate-specific antigen (37% vs 11%, p < 0.001).


CONCLUSION
Italian RO strongly supported ART, but their approach to patient selection for ART and SRT varied. Striking differences between Italian RO and American RO regarding ART and SRT practices were found.


ADVANCE IN KNOWLEDGE
Differential RT practices and perceptions exist among RO internationally. Clinical studies must inform evidence-based guidelines to harmonize the use of post-RP RT.