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Hasterok M, Szołtysik M, Nowicka Z, Goc B, Gräupner D, Majewski W, Rasławski K, Rajwa P, Jabłońska I, Magrowski Ł, Przydacz M, Krajewski W, Masri O, Miszczyk M. Rectum and Bladder Toxicity in Postoperative Prostate Bed Irradiation: Dose-Volume Parameters Analysis. Cancers (Basel) 2023; 15:5334. [PMID: 38001594 PMCID: PMC10670737 DOI: 10.3390/cancers15225334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Although prostate cancer treatment is increasingly effective, its toxicities pose a major concern. The aim of our study was to assess the rate of adverse events (AEs) and the prognostic value of dose-volume histogram (DVH) parameters for the occurrence of treatment toxicity in patients treated with post-prostatectomy prostate bed radiotherapy (RT). The AEs were scored according to the CTCAE v.5.0. The rectum and bladder were contoured according to the RTOG Guidelines. The DVH parameters were assessed using data exported from the ECLIPSE treatment-planning system. Genitourinary (GU) and gastrointestinal (GI) toxicity were analysed using consecutive dose thresholds for the percentage of an organ at risk (OAR) receiving a given dose and the QUANTEC dose constraints. A total of 213 patients were included in the final analysis. Acute grade 2 or higher (≥G2) GU AEs occurred in 18.7% and late in 21.3% of patients. Acute ≥G2 GI toxicity occurred in 11.7% and late ≥G2 in 11.2% of the patients. Five patients experienced grade 4 AEs. The most common adverse effects were diarrhoea, proctitis, cystitis, and dysuria. The most significant predictors of acute ≥G2 GI toxicity were rectum V47 and V46 (p < 0.001 and p < 0.001) and rectum wall V46 (p = 0.001), whereas the most significant predictors of late ≥G2 GI AEs were rectum wall V47 and V48 (p = 0.019 and p = 0.021). None of the bladder or bladder wall parameters was significantly associated with the risk of acute toxicity. The minimum doses to bladder wall (p = 0.004) and bladder (p = 0.005) were the most significant predictors of late ≥G2 GU toxicity. Postoperative radiotherapy is associated with a clinically relevant risk of AEs, which is associated with DVH parameters, and remains even in patients who fulfil commonly accepted dose constraints. Considering the lack of survival benefit of postoperative adjuvant RT, our results support delaying treatment through an early salvage approach to avoid or defer toxicity.
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Affiliation(s)
- Maja Hasterok
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Monika Szołtysik
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Mazowiecka 15, 92-215 Lodz, Poland;
| | - Bartłomiej Goc
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Donata Gräupner
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Wojciech Majewski
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Konrad Rasławski
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Paweł Rajwa
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Department of Urology, Medical University of Silesia, 3-go Maja 13-15, 41-800 Zabrze, Poland
| | - Iwona Jabłońska
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Łukasz Magrowski
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Krakow, Poland;
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, 50-556 Wrocław, Poland;
| | - Oliwia Masri
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
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Shimoyachi N, Yoshioka Y, Sasamura K, Yonese J, Yamamoto S, Yuasa T, Soyano T, Kozuka T, Oguchi M. Comparison Between Dose-Escalated Intensity Modulated Radiation Therapy and 3-Dimensional Conformal Radiation Therapy for Salvage Radiation Therapy After Prostatectomy. Adv Radiat Oncol 2021; 6:100753. [PMID: 34934854 PMCID: PMC8655408 DOI: 10.1016/j.adro.2021.100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To compare long-term outcomes and late toxicity between patients treated with 3-dimensional conformal radiation therapy (3D-CRT) and with dose-escalated intensity modulated radiation therapy (IMRT) as salvage radiation therapy (SRT) after prostatectomy. Methods and Materials A total of 110 patients who had been treated at our institution between 2010 and 2018 with SRT for biochemical recurrence after radical prostatectomy were included. The patients were treated either by 3D-CRT with 64 Gy (59 patients) or by IMRT with 70 Gy (51 patients). The irradiation target was the prostate bed only (106 patients) or the prostate bed and pelvic region (4 patients). Twelve patients (11%) received concurrent androgen deprivation therapy. The differences in clinical outcomes and late gastrointestinal (GI) and genitourinary (GU) toxicity between the 3D-CRT and IMRT groups were retrospectively assessed. Toxicities were recorded using the Common Terminology Criteria for Adverse Events, version 5.0. Prostate-specific antigen (PSA) progression after SRT was defined as an increase in the serum PSA level of 0.2 ng/mL from the PSA nadir after SRT and confirmed by a second PSA measurement that was higher than the first. Results The median follow-up time was 7.8 years for 3D-CRT (range:,0.3-9.2 years) and 3.1 years for IMRT (range, 0.4-7.2 years). There was no significant difference in the 4-year biochemical no-evidence-of-disease (bNED) rate between the 3D-CRT and IMRT groups (43.5% vs 52.1%; P = .20). Toxicity analysis showed no significant difference in late GI or GU toxicities of grade 2 or greater between the 3D-CRT and IMRT groups. The respective 4-year cumulative rates of toxicity in the 3D-CRT and IMRT groups were as follows: grade ≥2 GI toxicity, 8.8% and 4.4% (P = .42); grade ≥2 GU toxicity, 19.1% and 20.3% (P = .93); and grade ≥2 hematuria, 5.3% and 8.0% (P = .67). In the 3D-CRT group, the 8-year cumulative rates of GI toxicity, GU toxicity, and hematuria of grade 2 or greater were 8.8%, 28.4%, and 12.6%, respectively. Conclusions Dose-escalated IMRT showed no improvements in bNED or late toxicity compared with 3D-CRT. In addition, the results suggest that GU toxicity can occur after a long period (even after 6 years), whereas GI toxicity is seldom newly observed after 4 years.
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Affiliation(s)
- Nana Shimoyachi
- Departments of Radiation Oncology and
- Corresponding author: Nana Shimoyachi, MD
| | | | | | - Junji Yonese
- Urology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Yamamoto
- Urology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Yuasa
- Urology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Soyano
- Department of Radiology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Takuyo Kozuka
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
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Immunophenotype Rearrangement in Response to Tumor Excision May Be Related to the Risk of Biochemical Recurrence in Prostate Cancer Patients. J Clin Med 2021; 10:jcm10163709. [PMID: 34442004 PMCID: PMC8396861 DOI: 10.3390/jcm10163709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Prostate cancer (PCa) is known to exhibit a wide spectrum of aggressiveness and relatively high immunogenicity. The aim of this study was to examine the effect of tumor excision on immunophenotype rearrangements in peripheral blood and to elucidate if it is associated with biochemical recurrence (BCR) in high risk (HR) and low risk (LR) patients. Methods: Radical prostatectomy (RP) was performed on 108 PCa stage pT2–pT3 patients. Preoperative vs. postoperative (one and three months) immunophenotype profile (T- and B-cell subsets, MDSC, NK, and T reg populations) was compared in peripheral blood of LR and HR groups. Results: The BCR-free survival difference was significant between the HR and LR groups. Postoperative PSA decay rate, defined as ePSA, was significantly slower in the HR group and predicted BCR at cut-off level ePSA = −2.0% d−1 (AUC = 0.85 (95% CI, 0.78–0.90). Three months following tumor excision, the LR group exhibited a recovery of natural killer CD3 − CD16+ CD56+ cells, from 232 cells/µL to 317 cells/µL (p < 0.05), which was not detectable in the HR group. Prostatectomy also resulted in an increased CD8+ population in the LR group, mostly due to CD8+ CD69+ compartment (from 186 cells/µL before surgery to 196 cells/µL three months after, p < 001). The CD8+ CD69+ subset increase without total T cell increase was present in the HR group (p < 0.001). Tumor excision resulted in a myeloid-derived suppressor cell (MDSC) number increase from 12.4 cells/µL to 16.2 cells/µL in the HR group, and no change was detectable in LR patients (p = 0.12). An immune signature of postoperative recovery was more likely to occur in patients undergoing laparoscopic radical prostatectomy (LRP). Open RP (ORP) was associated with increased MDSC numbers (p = 0.002), whereas LRP was characterized by an immunity sparing profile, with no change in MDSC subset (p = 0.16). Conclusion: Tumor excision in prostate cancer patients results in two distinct patterns of immunophenotype rearrangement. The low-risk group is highly responsive, revealing postoperative restoration of T cells, NK cells, and CD8+ CD69+ numbers and the absence of suppressor MDSC increase. The high-risk group presented a limited response, accompanied by a suppressor MDSC increase and CD8+ CD69+ increase. The laparoscopic approach, unlike ORP, did not result in an MDSC increase in the postoperative period.
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Ferini G, Pergolizzi S. A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy. In Vivo 2021; 35:1379-1391. [PMID: 33910815 DOI: 10.21873/invivo.12390] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
This comprehensive synopsis summarizes the most relevant information obtained from a systematic analysis of studies of the last decade on radiation proctitis, one of the most feared radioinduced side effects among prostate cancer patients treated with curative external beam radiotherapy. The present review provides a useful support to radiation oncologists for limiting the onset or improving the treatment of radiation proctitis. This work shows that the past decade was a harbinger of significant new evidence in technological advances and technical tricks to avoid radiation proctitis, in addition to dosimetric perspectives and goals, understanding of pathogenesis, diagnostic work-up and treatment. We believe that a well-rounded knowledge of such an issue is fundamental for its appropriate management.
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Affiliation(s)
| | - Stefano Pergolizzi
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
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5
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Palumbo P, Manetta R, Izzo A, Bruno F, Arrigoni F, De Filippo M, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Biparametric (bp) and multiparametric (mp) magnetic resonance imaging (MRI) approach to prostate cancer disease: a narrative review of current debate on dynamic contrast enhancement. Gland Surg 2020; 9:2235-2247. [PMID: 33447576 DOI: 10.21037/gs-20-547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prostate cancer is the most common malignancy in male population. Over the last few years, magnetic resonance imaging (MRI) has proved to be a robust clinical tool for identification and staging of clinically significant prostate cancer. Though suggestions by the European Society of Urogenital Radiology to use complete multiparametric (mp) T2-weighted/diffusion weighted imaging (DWI)/dynamic contrast enhancement (DCE) acquisition for all prostate MRI examinations, the real advantage of functional DCE remains a matter of debate. Recent studies demonstrate that biparametric (bp) and mp approaches have similar accuracy, but controversial evidences remain, and the specific potential benefits of contrast medium administration are still poorly discussed in literature. The bp approach is in fact sufficient in most cases to adequately identify a negative test, or to accurately define the degree of aggressiveness of a lesion, especially if larger or with major characteristics of malignancy. This feature would give the DCE a secondary role, probably limited to a second evaluation of the lesion location, for detecting small cancer or in case of controversy. However, DCE has proved to increase the sensitivity of prostate MRI, though a less specificity. Therefore, an appropriate decision algorithm is needed to standardize the MRI approach. Aim of this review study was to provide a schematic description of bpMRI and mpMRI approaches in the study of prostatic anatomy, focusing on comparative validity and current DCE application. Additional theoretical considerations on prostate MRI are provided.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Manetta
- Radiology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - Antonio Izzo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Parma, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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6
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Ziglioli F, Maestroni U, Manna C, Negrini G, Granelli G, Greco V, Pagnini F, De Filippo M. Multiparametric MRI in the management of prostate cancer: an update-a narrative review. Gland Surg 2020; 9:2321-2330. [PMID: 33447583 DOI: 10.21037/gs-20-561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The growing interest in multiparametric MRI is leading to important changes in the diagnostic process of prostate cancer. MRI-targeted biopsy is likely to become a standard for the diagnosis of prostate cancer in the next years. Despite it is well known that MRI has no role as a staging technique, it is clear that multiparametric MRI may be of help in active surveillance protocols. Noteworthy, MRI in active surveillance is not recommended, but a proper understanding of its potential may be of help in achieving the goals of a delayed treatment strategy. Moreover, the development of minimally invasive techniques, like laparoscopic and robotic surgery, has led to greater expectations as regard to the functional outcomes of radical prostatectomy. Multiparametric MRI may play a role in planning surgical strategies, with the aim to provide the highest oncologic outcome with a minimal impact on the quality of life. We maintain that a proper anatomic knowledge of prostate lesions may allow the surgeon to achieve a better result in planning as well as in performing surgery and help the surgeon and the patient engage in a shared decision in planning a more effective strategy for prostate cancer control and treatment. This review highlights the advantages and the limitations of multiparametric MRI in prostate cancer diagnosis, in active surveillance and in planning surgery.
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Affiliation(s)
| | | | - Carmelinda Manna
- Department of Radiology, University-Hospital of Parma, Parma, Italy
| | - Giulio Negrini
- Department of Radiology, University-Hospital of Parma, Parma, Italy
| | - Giorgia Granelli
- Department of Urology, University-Hospital of Parma, Parma, Italy
| | - Valentina Greco
- Department of Radiology, University-Hospital of Parma, Parma, Italy
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7
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Francolini G, Detti B, Bottero M, Zilli T, Lancia A, Bruni A, Borghesi S, Mariotti M, Castellucci P, Fanti S, Filippi AR, Teriaca MA, Maragna V, Aristei C, Mazzeo E, Livi L, Ingrosso G. Detection rate, pattern of relapse and influence on therapeutic decision of PSMA PET/CT in patients affected by biochemical recurrence after radical prostatectomy, a retrospective case series. Clin Transl Oncol 2020; 23:364-371. [PMID: 32602076 DOI: 10.1007/s12094-020-02427-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
Abstract
AIMS 68Ga-Prostate-specific membrane antigen (PSMA) PET/CT is widely used in patients with biochemical recurrence (BCR) after radical prostatectomy. We collected data about patients staged with PSMA PET/CT after BCR (PSA < 1 ng/ml) in four different institutes. Impact of baseline features (Gleason score, risk classification, PSA at recurrence, PSA doubling time and time to recurrence) was explored to understand predictive factors of (PSMA) PET/CT positivity. Impact of restaging on following treatment approaches was reported. RESULTS 92 patients were included. PSMA PET/CT detection rate was 56.5% and low-volume disease (≤ 3 non-visceral lesions) was detected in 52.2% of patients. After positive scan, 13.5% of patients still lies on observation, ADT alone was administered in 30.8% of cases, Stereotactic body RT (SBRT) alone was delivered to 44.2% of patients and 11.5% of patients underwent concomitant SBRT and ADT. Seven patients underwent conventional salvage prostate bed RT. Chi-squared test showed a higher rate of positive PSMA PET/CT for patients with Gleason score > 7 (p = 0.004) and TTR < 29.5 months (p = 0.003). CONCLUSIONS PSMA PET/CT showed a high detection rate. This influenced clinical management in a significant percentage of patients, allowing treatment tailoring on the basis of imaging.
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Affiliation(s)
- G Francolini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - B Detti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - M Bottero
- Department of Radiation Oncology, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - T Zilli
- Radiation Oncology Division, Geneva University Hospital, Geneva, Switzerland
| | - A Lancia
- Radiation Oncology Unit, Department of Medical Sciences and Infectious Disease, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - A Bruni
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - S Borghesi
- UOC Radiation Oncology Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - M Mariotti
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - P Castellucci
- Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - S Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - A R Filippi
- Radiation Oncology Unit, Department of Medical Sciences and Infectious Disease, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - M A Teriaca
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - V Maragna
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - C Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
| | - E Mazzeo
- Radiotherapy Unit, University Hospital of Modena, Modena, Italy
| | - L Livi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - G Ingrosso
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia, Perugia, Italy
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8
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Tao R, Dai J, Bai Y, Yang J, Sun G, Zhang X, Zhao J, Zeng H, Shen P. The prognosis benefits of adjuvant versus salvage radiotherapy for patients after radical prostatectomy with adverse pathological features: a systematic review and meta-analysis. Radiat Oncol 2019; 14:197. [PMID: 31706339 PMCID: PMC6842460 DOI: 10.1186/s13014-019-1384-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/23/2019] [Indexed: 02/05/2023] Open
Abstract
Background The appropriate timing of radiotherapy (RT) for patients after radical prostatectomy (RP) with adverse pathological features (APFs) remains controversial. This systematic review was conducted to compare the efficacy of adjuvant radiotherapy (ART) and salvage radiotherapy (SRT). Methods PubMed, EMBASE, Web of Science and the Cochrane Library electronic databases were searched to retrieve the required. The hazard ratio (HR) and corresponding 95% confidence interval (CI) of overall survival (OS), biochemical recurrence-free survival (BRFS) and distant metastases-free survival (DMFS) were extracted. The survival benefits of ART with SRT (including early salvage radiotherapy (ESRT)) were analyzed. The process of the meta-analysis was performed with RevMan version 5.3. Results A total of fifteen retrospective studies were finally included in the final analysis including 5586 patients. The pooled analysis indicated that ART could achieve better control of prostate cancer and improve OS (p = 0.0006), BRFS (p < 0.0001) and DMFS (p < 0.0001), when compared to SRT. The subgroup analysis of the 5-year OS rate demonstrated that the ART group still had survival advantages compared to the SRT group (p = 0.0006). However, ART and SRT were comparable in 10-year OS rate (p = 0.07). ART had advantages over SRT in both 5-year (p = 0.0003) and 10-year BRFS (p = 0.0003). The subgroup analysis with different follow-up starting points from RP or RT was essentially consistent with the above results. The pooled analysis also showed that ART was superior to ESRT on OS (p = 0.008) and DMFS (p = 0.03), and comparable to ESRT on BRFS (p = 0.1). Conclusions According to this meta-analysis, ART could be served as a preferential treatment for patients with APFs after RP to improve prognosis. Certainly, high-quality, multicenter randomized controlled trials (RCTs) are expecting to confirm the outcomes of our meta-analysis in the future.
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Affiliation(s)
- Ronggui Tao
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Yunjin Bai
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Jiyu Yang
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Xingming Zhang
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Jinge Zhao
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China
| | - Pengfei Shen
- Department of Urology, Institute of Urology, and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, China.
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9
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Buglione M, Noale M, Bruni A, Antonelli A, Bertoni F, Corvo’ R, Ricardi U, Borghetti P, Maddalo M, Simeone C, Mazzeo E, Porreca A, Serni S, Bassi P, Gacci M, Mirone V, Montironi R, Tubaro A, Berruti A, Conti GN, Maggi S, Magrini SM, Triggiani L. Treatment paths for localised prostate cancer in Italy: The results of a multidisciplinary, observational, prospective study (Pros-IT CNR). PLoS One 2019; 14:e0224151. [PMID: 31675380 PMCID: PMC6824566 DOI: 10.1371/journal.pone.0224151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/06/2019] [Indexed: 12/22/2022] Open
Abstract
Background There are several treatments available to newly diagnosed prostate cancer (PCA) patients. Although surgery and radiotherapy (RT) with or without androgen deprivation therapy (ADT) are widely adopted treatment options for localized PCA together with active surveillance (AS), there is no consensus nor randomised trials on treatment selection, prospective quality of life (QOL), along with toxicity outcomes and according to treatment modality in the Italian population. The current study aimed to describe clinical-therapeutic features and QOL at PCA diagnosis, according to different treatment patterns in a large prospective, Italian population, enrolled in the Pros-IT CNR study. Methods The Pros-IT CNR is an on-going national, multicenter, observational, prospective study on patients affected by PCA who have been referred by 97 Italian Urology, Radiation Oncology and Medical Oncology facilities participating in the project. The possible relationships between the treatment patterns reported in the 6 month follow-up case report form and patients’ features at diagnosis were evaluated using exploratory multiple correspondence analysis (MCA) and other data analysis method. Results At diagnosis, surgery and AS patients were significantly younger, had fewer comorbidities, lower PSA levels and Gleason Score (GS) values; they were also diagnosed at an earlier stage of disease with respect to the RT or ADT patients who showed significantly worse QoL scores at the time of diagnosis. Conclusions An analysis of the data collected at baseline and 6 months later uncovered substantial differences in ages, comorbidities, clinical and QOL features in the various treatment groups. These findings do not fully reflect the current PCA treatment guidelines and suggest the need for a multidisciplinary consensus guideline to ameliorate both the counselling and treatments of PCA patients.
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Affiliation(s)
- Michela Buglione
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Alessio Bruni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
- * E-mail:
| | | | - Filippo Bertoni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Renzo Corvo’
- Department of Radiation Oncology, University Hospital “Policlinico San Martino”, Genoa, Italy
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, School of Medicine—University of Turin, Turin, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - Marta Maddalo
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - Claudio Simeone
- Department of Urology, University and Spedali Civili Hospital, Brescia, Italy
| | - Ercole Mazzeo
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Angelo Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Sergio Serni
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | - Pierfrancesco Bassi
- Department of Urology, Catholic University of Rome, Policlinico Gemelli, Rome, Italy
| | - Mauro Gacci
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | | | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine–Ospedali Riuniti, Ancona, Italy
| | - Andrea Tubaro
- Urology Unit, Sant'Andrea Hospital, "La Sapienza" University, Rome, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, ASST-Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
| | - Luca Triggiani
- Radiation Oncology Department, University and Spedali Civili Hospital, Brescia, Italy
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10
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Bruni A, Ingrosso G, Trippa F, Di Staso M, Lanfranchi B, Rubino L, Parente S, Frassinelli L, Maranzano E, Santoni R, Sighinolfi MC, Lohr F, Mazzeo E. Macroscopic locoregional relapse from prostate cancer: which role for salvage radiotherapy? Clin Transl Oncol 2019; 21:1532-1537. [PMID: 30868389 DOI: 10.1007/s12094-019-02084-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/07/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Salvage radiotherapy (SRT) after radical prostatectomy for prostate cancer (PCa) is recommended as soon as PSA rises above 0.20 ng/ml, but many patients (pts) still experience local macroscopic relapse. The aim of this multicentric retrospective analysis was to evaluate the role of SRT in pts with macroscopic relapse. MATERIALS AND METHODS From 2001 to 2016, 105 consecutive pts with macroscopic PCa relapse underwent SRT ± androgen deprivation therapy (ADT). Mean age was 72 years. At time of relapse, 29 pts had a PSA value < 1.0 ng/mL, 50 from 1.1 to 5, and 25 pts > 5. Before SRT, 23 pts had undergone 18F-choline PET and 15 pts pelvic MRI. Ninety-four pts had prostatic bed relapse only, and four nodal involvement. Fifty-one pts were previously submitted to first-line ADT, while 6 pts received ≥ 2 lines. RESULTS At a median follow-up of 52 months, 89 pts were alive, while 16 were dead. Total RT dose to macroscopic lesions was > 70 Gy in 58 pts, 66-70 Gy in 43, and < 66 Gy in 4 pts. In 72 pts, target volume encompassed only the prostatic bed with sequential boost to macroscopic site; 33 pts received prophylactic pelvic RT. Ten-year overall survival was 76.1%, while distant metastasis-free survival was 73.3%. No grade 4-5 toxicities were found. CONCLUSIONS SRT ± ADT for macroscopic relapse showed a favorable oncological outcome supporting its important role in this scenario. Data from this series suggest that SRT may either postpone ADT or improve results over ADT alone in appropriately selected pts.
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Affiliation(s)
- A Bruni
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy.
| | - G Ingrosso
- Radiotherapy Unit, "Tor Vergata" University General Hospital, Rome, Italy
| | - F Trippa
- Radiotherapy Unit, "Santa Maria" University Hospital, Terni, Italy
| | - M Di Staso
- Radiotherapy Unit, "Nuovo San Salvatore" Hospital, L'Aquila, Italy
| | - B Lanfranchi
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - L Rubino
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - S Parente
- Radiotherapy Unit, "Nuovo San Salvatore" Hospital, L'Aquila, Italy
| | - L Frassinelli
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - E Maranzano
- Radiotherapy Unit, "Santa Maria" University Hospital, Terni, Italy
| | - R Santoni
- Radiotherapy Unit, "Tor Vergata" University General Hospital, Rome, Italy
| | - M C Sighinolfi
- Urology Unit, University Hospital of Modena, Modena, Italy
| | - F Lohr
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - E Mazzeo
- Radiotherapy Unit, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
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11
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Halkett GKB, Wigley CA, Aoun SM, Portaluri M, Tramacere F, Livi L, Detti B, Arcangeli S, Lund JA, Kristensen A, McFadden N, Grun A, Bydder S, Sackerer I, Greimel E, Spry N. International validation of the EORTC QLQ-PRT20 module for assessment of quality of life symptoms relating to radiation proctitis: a phase IV study. Radiat Oncol 2018; 13:162. [PMID: 30157890 PMCID: PMC6116442 DOI: 10.1186/s13014-018-1107-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 08/20/2018] [Indexed: 01/02/2023] Open
Abstract
Background Although patients experience radiation proctitis post radiotherapy no internationally tested instruments exist to measure these symptoms. This Phase IV study tested the scale structure, reliability and validity and cross-cultural applicability of the EORTC proctitis module (QLQ-PRT23) in patients who were receiving pelvic radiotherapy. Methods Patients (n = 358) from six countries completed the EORTC QLQ-C30, QLQ-PRT23 and EORTC Quality of Life Group debriefing questions. Clinicians completed the EORTC Radiation Therapy Oncology Group scale. Questionnaires were completed at four time-points. The module’s scale structure was examined and validated using standard psychometric analysis techniques. Results Three items were dropped from the module (QLQ-PRT23 → QLQ-PRT20). Factor analysis identified five factors in the module: bowel control; bloating and gas; emotional function/lifestyle; pain; and leakage. Inter-item correlations were within r = 0.3–0.7. Test-Retest reliability was high. All multi-item scales discriminated between patients showing symptoms and those without symptomology. The module discriminated symptoms from the clinician completed scoring and for age, gender and comorbidities. Conclusion The EORTC QLQ-PRT20 is designed to be used in addition to the EORTC QLQ-C30 to measure quality of life in patients who receive pelvic radiotherapy. The EORTC QLQ-PRT20 is quick to complete, acceptable to patients, has good content validity and high reliability. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000972224. Electronic supplementary material The online version of this article (10.1186/s13014-018-1107-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georgia K B Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Institute for Health Research, University of Notre Dame, Perth, Western Australia.
| | - Charles Adam Wigley
- Institute for Health Research, University of Notre Dame, Perth, Western Australia
| | - Samar M Aoun
- Institute for Health Research, University of Notre Dame, Perth, Western Australia.,Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Maurizio Portaluri
- Radiation Oncology Dept. "A. Perrino" General Hospital, ASL Brindisi, Italy
| | | | | | | | | | - Jo-Asmund Lund
- Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Are Kristensen
- Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Nathalie McFadden
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Arne Grun
- Charité - University Medicine, Berlin, Germany
| | - Sean Bydder
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Irina Sackerer
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany.,Radiation Oncology, Freising and Dachau, Germany
| | | | - Nigel Spry
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia.,Genesis Cancer Care, Joondalup, WA, Australia
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