Tumori, 91: 156-162, 2005 Introduction Local recurrence after radical prostatectomy for lo- calized prostate cancer occurs approximately in one- third of patients, with reported ranges comprised be- tween 10-15% to 40-50%. The reasons for these differ- ences are related to the different selection criteria used for radical prostatectomy and to the experience of the surgeon performing the radical prostatectomy. In fact, 30-50% of patients staged as having organ-confined disease (cT1-T2) are classified as pT3 after surgery 1-4 . To improve local control in patients with unfavorable prognostic factors, postoperative radiotherapy can be applied with an adjuvant as well as salvage intent after radical prostatectomy. Retrospective studies have shown that radiotherapy reduces the local recurrence rate, but an impact on survival has not been demonstrat- ed. The optimal timing of postoperative radiotherapy, the prescription dose and the treatment technique still remains unclear 5,6 . Serum prostate-specific antigen (PSA) level is widely used in the modern era to monitor outcome of prostate cancer after radiotherapy, and a rising PSA level often signifies a recurrence of tumor 7-9 . Radiotherapy to the prostate bed has been used to treat patients with rising PSA after radical prostatectomy and in this situation is generally referred to as salvage radiotherapy. However, there are no randomized prospective but only retrospec- tive studies to confirm the role of radiotherapy after radical prostatectomy 10-12 . Recent data coming from EORTC trial 22911 13 has confirmed that postoperative radiotherapy results in im- proved biochemical and clinical progression-free sur- vival in case of high-risk factors in the adjuvant setting. The AIRO (Associazione Italiana Radioterapia On- cologica) National Working Group on Prostate Radio- Correspondence to: Giuseppe Malinverni MD, Coordinator of the Postoperative Radiotherapy Sub-Group, AIRO National Working Group on Prostate Radiotherapy, IRCC, Institute for Cancer Research and Treatment, Strada Provinciale 142 Km 3,95 – 10060 Candiolo (Turin) Italy. Tel +39-011-9933706; fax +39-011-9933752; e-mail gmalinverni@libero.it Acknowledgments: The authors wish to thank Mrs Tiziana Magnani, secretary of the Gruppo Nazionale AIRO Prostata, for her cooperation and the Fondazione Italo Monzino for the finantial support. Received April 21, 2004; accepted November 26, 2004 ITALIAN SURVEY IN POSTOPERATIVE RADIATION THERAPY FOR PROSTATE CARCINOMA BY THE AIRO NATIONAL WORKING GROUP ON PROSTATE RADIOTHERAPY: DEFINITIVE RESULTS Giuseppe Malinverni, Carlo Greco, Pieromaria Bianchi, Luciano Busutti, Emanuela Cagna, Cesare Cozzarini, Massimo Del Duca, Paola Franzone, Giovanni Frezza, Pietro Gabriele, Domenico Genovesi, Giuseppe Franco Girelli, Corrado Italia, Giovanni Mandoliti, Floranna Mauro, Simonetta Nava, Silvia Pratissoli, Maria Bianca Saracino, Luigi Squillace, Marco Signor, Angiolo Tagliagambe,Vittorio Vavassori, Sergio Villa, Giampaolo Zini, and Riccardo Valdagni AIRO (Associazione Italiana Radioterapia Oncologica) National Working Group on Prostate Radiotherapy, Italy Key words: adjuvant radiotherapy, postoperative radiotherapy, prostate carcinoma, salvage radiotherapy, survey. Aims and background: The National Working Group on Prostate Radiotherapy of AIRO (Associazione Italiana Radioterapia On- cologica, Italian Association of Radiotherapeutic Oncology) was established in March 2001. A retrospective multi-center survey was performed to analyze the patterns of care for prostate cancer patients treated with postoperative radiother- apy following radical prostatectomy in Italy with regard to the year 2000. Materials and methods: A structured questionnaire was mailed to 47 Italian radiotherapy centers to assess patient accrual in the postoperative setting in the interval comprised between period January-December 2000. Numbers of patients treated for different stages, specific prognostic factors indicating the need for adjuvant radiotherapy, fractionation schedules and prescription doses were acquired as well as other clinically important factors such as radiotherapy timing and the use of hormone therapy. More technical features of the treatment, such as patient positioning, mode of simulation, typical field setup and dose prescription criteria were also included in the questionnaire. Results: The questionnaire was returned by 24 radiotherapy In- stitutions (51%) with a total number of 470 patients treated postoperatively in the year 2000. An average of about 20 pa- tients were enrolled by each radiotherapy center. The age range was 45-81 years. Radiotherapy was delivered within 6 months of radical prostatectomy in 297 patients (65.4%) (mean, 3.4 months). In 157 (34.6%), the treatment was deliv- ered as a salvage approach for biochemical or micro-macro- scopic recurrence. Most of patients had locally advanced stage disease (pT3-pT4) (76%). Unfavorable prognostic fac- tors, such as positive margins, capsular invasion, Gleason pattern score >7 were present in about 50% of patients. Conclusions: The study confirmed that important risk factors for recurrences are present in a significant percentage of pa- tients treated by radical prostatectomy. The number of pa- tients that would benefit from adjuvant radiotherapy is there- fore potentially very large. Future prospective studies should be conducted to assess and to clarify the respective roles of adjuvant and salvage radiotherapy in prostate cancer pa- tients.