© 2009 THE AUTHORS 1624 JOURNAL COMPILATION © 2 0 0 9 B J U I N T E R N A T I O N A L | 1 0 4 , 1 6 2 4 – 1 6 3 0 | doi:10.1111/j.1464-410X.2009.08668.x 2009 THE AUTHORS. JOURNAL COMPILATION 2009 BJU INTERNATIONAL Urological Oncology INTRAOPERATIVE RADIOTHERAPY DURING RADICAL PROSTATECTOMY FOR INTERMEDIATE-RISK TO LOCALLY ADVANCED PROSTATE CANCER ROCCO et al. Intraoperative radiotherapy during radical prostatectomy for intermediate-risk to locally advanced prostate cancer: treatment technique and evaluation of perioperative and functional outcome vs standard radical prostatectomy, in a matched-pair analysis Bernardo Rocco*, Barbara A. Jereczek-Fossa †‡ , Deliu-Victor Matei*, Fabrizio Verweij*, Luigi Santoro § , Andrea Vavassori † , Juan Camillo Ospina*, Francisco Cedeira*, Mario Ciocca ¶ , Roberto Orecchia †‡ and Ottavio de Cobelli* ‡ *Division of Urology, † Radiation Oncology, ¶ Medical Physics and § Epidemiology and Biostatistics Division, European Institute of Oncology, and ‡ Faculty of Medicine, University of Milan, Milan, Italy Accepted for publication 18 March 2009 delivered by a mobile linear accelerator in the operating room (electron beam, 12 Gy at 90% isodose). According to the pathological findings further adjuvant radio- or hormone therapy could be administered. The median follow-up was 16 months. This group was compared retrospectively with a historical group of 100 patients who had undergone RRP and further adjuvant therapy, selected with equivalent criteria. The comparison was conducted as a matched-pair analysis. The perioperative outcomes (surgical time, estimated blood loss, blood transfusions, days of catheterization, days of drainage, days of hospitalization), continence as the functional outcome, acute and late toxicity, rate of complications and bPFS were evaluated and compared. RESULTS The baseline characteristics of the two groups were equivalent but the node count and the number of positive lymph nodes was higher in the IORT group. The IORT group had longer surgery, and a shorter hospital stay and catheterization. There were no differences in continence rate, and no major complications in either group. The acute and late toxicity and bPFS were equivalent. A retrospective comparison and the short follow-up were the major limitations. CONCLUSIONS IORT administered before RRP seems a feasible approach, with little effect on the variables evaluated. KEYWORDS intraoperative radiotherapy, prostate cancer, prostatectomy, toxicity, continence Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate a novel approach with intraoperative radiotherapy (IORT) administered in the surgical field, after pelvic lymphadenectomy (PL) and before radical retropubic prostatectomy (RRP), evaluating acute and late toxicity, complications and biochemical progression-free survival (bPFS), as the adequate treatment of locally advanced prostate cancer is still a controversial issue. PATIENTS AND METHODS Between June 2005 and October 2007, 33 consecutive patients with intermediate-risk or locally advanced prostate cancer were selected for PL + IORT + RRP. IORT was INTRODUCTION The treatment of locally advanced prostate cancer is a controversial issue. According to USA National Cancer Institute guidelines, external beam radiotherapy (EBRT) using a linear accelerator would be the most appropriate treatment for most patients with advanced prostate cancer [1]. Nevertheless, based on recent studies, the European Association of Urology (EAU) guidelines suggest a role also for radical prostatectomy (RRP) as a primary treatment in T3 disease [2]; according to the study by Ward et al. [3] the cancer-specific survival rates were 95%, 90% and 79% at 5, 10 and 15 years in patients who had a RRP for cT3 disease. Moreover, Hsu et al. [4] report a cancer-specific survival rate of 98.7% and 91.6% at 5 and 10 years in patients with clinical unilateral T3a disease. However, a multimodal approach in cT3 disease is advisable [2]. Bolla et al. [5] showed that adjuvant EBRT after RRP improves the clinical and biochemical disease-free survival rate in patients with pathologically locally advanced BJUI BJU INTERNATIONAL