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Sundahl N, Brand D, Parker C, Dearnaley D, Tree A, Pathmanathan A, Suh YE, Van As N, Eeles R, Khoo V, Huddart R, Murray J. Weekly ultra-hypofractionated radiotherapy in localised prostate cancer. Clin Transl Radiat Oncol 2024; 47:100800. [PMID: 38872938 PMCID: PMC11170089 DOI: 10.1016/j.ctro.2024.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/10/2024] [Accepted: 05/25/2024] [Indexed: 06/15/2024] Open
Abstract
Background Moderately hypofractionated radiotherapy regimens or stereotactic body radiotherapy (SBRT) are standard of care for localised prostate cancer. However, some patients are unable or unwilling to travel daily to the radiotherapy department and do not have access to, or are not candidates for, SBRT. For many years, The Royal Marsden Hospital NHS Foundation Trust has offered a weekly ultra-hypofractionated radiotherapy regimen to the prostate (36 Gy in 6 weekly fractions) to patients unable/unwilling to travel daily. Methods The current study is a retrospective analysis of all patients with non-metastatic localised prostate cancer receiving this treatment schedule from 2010 to 2015. Results A total of 140 patients were included in the analysis, of whom 86 % presented with high risk disease, with 31 % having Gleason Grade Group 4 or 5 disease and 48 % T3 disease or higher. All patients received hormone treatment, and there was often a long interval between start of hormone treatment and start of radiotherapy (median of 11 months), with 34 % of all patients having progressed to non-metastatic castrate-resistant disease prior to start of radiotherapy. Median follow-up was 52 months. Median progression-free survival (PFS) and overall survival (OS) for the whole group was 70 months and 72 months, respectively. PFS and OS in patients with hormone-sensitive disease at time of radiotherapy was not reached and 75 months, respectively; and in patients with castrate-resistant disease at time of radiotherapy it was 20 months and 61 months, respectively. Conclusion Our data shows that a weekly ultra-hypofractionated radiotherapy regimen for prostate cancer could be an option in those patients for whom daily treatment or SBRT is not an option.
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Affiliation(s)
- Nora Sundahl
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
- Department of Radiation Oncology, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium
| | - Douglas Brand
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
- Department of Medical Physics and Bioengineering, University College London, Gower St, WC1E 6BT London, UK
| | - Chris Parker
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
| | - David Dearnaley
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
| | - Alison Tree
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
| | - Angela Pathmanathan
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
| | - Yae-eun Suh
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
| | - Nicholas Van As
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
| | - Rosalind Eeles
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Vincent Khoo
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
| | - Robert Huddart
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
| | - Julia Murray
- Urological Oncology Department, Royal Marsden Hospital NHS Foundation Trust, London & Sutton, UK
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London & Sutton, UK
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Koerber SA, Höcht S, Aebersold D, Albrecht C, Boehmer D, Ganswindt U, Schmidt-Hegemann NS, Hölscher T, Mueller AC, Niehoff P, Peeken JC, Pinkawa M, Polat B, Spohn SKB, Wolf F, Zamboglou C, Zips D, Wiegel T. Prostate cancer and elective nodal radiation therapy for cN0 and pN0-a never ending story? : Recommendations from the prostate cancer expert panel of the German Society of Radiation Oncology (DEGRO). Strahlenther Onkol 2024; 200:181-187. [PMID: 38273135 PMCID: PMC10876748 DOI: 10.1007/s00066-023-02193-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024]
Abstract
For prostate cancer, the role of elective nodal irradiation (ENI) for cN0 or pN0 patients has been under discussion for years. Considering the recent publications of randomized controlled trials, the prostate cancer expert panel of the German Society of Radiation Oncology (DEGRO) aimed to discuss and summarize the current literature. Modern trials have been recently published for both treatment-naïve patients (POP-RT trial) and patients after surgery (SPPORT trial). Although there are more reliable data to date, we identified several limitations currently complicating the definitions of general recommendations. For patients with cN0 (conventional or PSMA-PET staging) undergoing definitive radiotherapy, only men with high-risk factors for nodal involvement (e.g., cT3a, GS ≥ 8, PSA ≥ 20 ng/ml) seem to benefit from ENI. For biochemical relapse in the postoperative situation (pN0) and no PSMA imaging, ENI may be added to patients with risk factors according to the SPPORT trial (e.g., GS ≥ 8; PSA > 0.7 ng/ml). If PSMA-PET/CT is negative, ENI may be offered for selected men with high-risk factors as an individual treatment approach.
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Affiliation(s)
- S A Koerber
- Department of Radiation Oncology, Barmherzige Brüder Hospital Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - S Höcht
- Department of Radiation Oncology, Ernst von Bergmann Hospital Potsdam, Charlottenstraße 72, 14467, Potsdam, Germany
| | - D Aebersold
- Department of Radiation Oncology, Inselspital-Bern University Hospital, University of Bern, Freiburgstraße 4, 3010, Bern, Switzerland
| | - C Albrecht
- Nordstrahl Radiation Oncology Unit, Nürnberg North Hospital, Prof.-Ernst-Nathan-Str. 1, 90149, Nürnberg, Germany
| | - D Boehmer
- Department of Radiation Oncology, University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Ganswindt
- Department of Radiation Oncology, University Hospital Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - N-S Schmidt-Hegemann
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Fiedlerstraße 19, 01307, Dresden, Germany
| | - A-C Mueller
- Department of Radiation Oncology, RKH Hospital Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany
| | - P Niehoff
- Department of Radiation Oncology, Sana Hospital Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - J C Peeken
- Department of Radiation Oncology, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - M Pinkawa
- Department of Radiation Oncology, Robert Janker Klinik, Villenstraße 8, 53129, Bonn, Germany
| | - B Polat
- Department of Radiation Oncology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - S K B Spohn
- Department of Radiation Oncology, University Hospital Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
| | - F Wolf
- Department of Radiation Oncology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - C Zamboglou
- Department of Radiation Oncology, University Hospital Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
- German Oncology Center, 1, Nikis Avenue, Agios Athanasios, 4108, Limassol, Cyprus
| | - D Zips
- Department of Radiation Oncology, University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Houlihan OA, Redmond K, Fairmichael C, Lyons CA, McGarry CK, Mitchell D, Cole A, O'Connor J, McMahon S, Irvine D, Hyland W, Hanna M, Prise KM, Hounsell AR, O'Sullivan JM, Jain S. A Randomized Feasibility Trial of Stereotactic Prostate Radiation Therapy With or Without Elective Nodal Irradiation in High-Risk Localized Prostate Cancer (SPORT Trial). Int J Radiat Oncol Biol Phys 2023; 117:594-609. [PMID: 36893820 DOI: 10.1016/j.ijrobp.2023.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/06/2023] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE The aim of this study was to establish the feasibility of a randomized clinical trial comparing SABR with prostate-only (P-SABR) or with prostate plus pelvic lymph nodes (PPN-SABR) in patients with unfavorable intermediate- or high-risk localized prostate cancer and to explore potential toxicity biomarkers. METHODS AND MATERIALS Thirty adult men with at least 1 of the following features were randomized 1:1 to P-SABR or PPN-SABR: clinical magnetic resonance imaging stage T3a N0 M0, Gleason score ≥7 (4+3), and prostate-specific antigen >20 ng/mL. P-SABR patients received 36.25 Gy/5 fractions/29 days, and PPN-SABR patients received 25 Gy/5 fractions to pelvic nodes, with the final cohort receiving a boost to the dominant intraprostatic lesion of 45 to 50 Gy. Phosphorylated gamma-H2AX (γH2AX) foci numbers, citrulline levels, and circulating lymphocyte counts were quantified. Acute toxicity information (Common Terminology Criteria for Adverse Events, version 4.03) was collected weekly at each treatment and at 6 weeks and 3 months. Physician-reported late Radiation Therapy Oncology Group (RTOG) toxicity was recorded from 90 days to 36 months postcompletion of SABR. Patient-reported quality of life (Expanded Prostate Cancer Index Composite and International Prostate Symptom Score) scores were recorded with each toxicity time point. RESULTS The target recruitment was achieved, and treatment was successfully delivered in all patients. A total of 0% and 6.7% (P-SABR) and 6.7% and 20.0% (PPN-SABR) experienced acute grade ≥2 gastrointestinal (GI) and genitourinary (GU) toxicity, respectively. At 3 years, 6.7% and 6.7% (P-SABR) and 13.3% and 33.3% (PPN-SABR) had experienced late grade ≥2 GI and GU toxicity, respectively. One patient (PPN-SABR) had late grade 3 GU toxicity (cystitis and hematuria). No other grade ≥3 toxicity was observed. In addition, 33.3% and 60% (P-SABR) and 64.3% and 92.9% (PPN-SABR) experienced a minimally clinically important change in late Expanded Prostate Cancer Index Composite bowel and urinary summary scores, respectively. γH2AX foci numbers at 1 hour after the first fraction were significantly higher in the PPN-SABR arm compared with the P-SABR arm (P = .04). Patients with late grade ≥1 GI toxicity had significantly greater falls in circulating lymphocytes (12 weeks post-radiation therapy, P = .01) and a trend toward higher γH2AX foci numbers (P = .09) than patients with no late toxicity. Patients with late grade ≥1 bowel toxicity and late diarrhea experienced greater falls in citrulline levels (P = .05). CONCLUSIONS A randomized trial comparing P-SABR with PPN-SABR is feasible with acceptable toxicity. Correlations of γH2AX foci, lymphocyte counts, and citrulline levels with irradiated volume and toxicity suggest potential as predictive biomarkers. This study has informed a multicenter, randomized, phase 3 clinical trial in the United Kingdom.
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Affiliation(s)
- Orla A Houlihan
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland; Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland.
| | - Kelly Redmond
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| | - Ciaran Fairmichael
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland; Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| | - Ciara A Lyons
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland; Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| | - Conor K McGarry
- Department of Radiotherapy Medical Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Darren Mitchell
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Aidan Cole
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - John O'Connor
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| | - Stephen McMahon
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| | - Denise Irvine
- Department of Radiotherapy Medical Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Wendy Hyland
- Department of Radiotherapy Medical Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Michael Hanna
- Northern Ireland Cancer Trials Network, Belfast City Hospital, Belfast, Northern Ireland
| | - Kevin M Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| | - Alan R Hounsell
- Department of Radiotherapy Medical Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Joe M O'Sullivan
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Suneil Jain
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland; Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
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Guerini AE, Noale M, Mortellaro G, Lisi R, Bruni A, Santini R, Muto P, Ferrera G, Cossali G, Morelli V, Magrini SM, Spiazzi L, Buglione M. Early results of PRO-EPI: PROspective multicenter observational study on elective pelvic nodes irradiation in patients with intermediate/high/very high-risk non-metastatic prostate cancer submitted to radical, adjuvant, or salvage radiotherapy with or without concomitant androgen deprivation therapy. Front Oncol 2022; 12:951220. [PMID: 36408148 PMCID: PMC9666761 DOI: 10.3389/fonc.2022.951220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary: Although radiotherapy plays a fundamental role in the management of intermediate/high/very high-risk non-metastatic prostatic cancer (IHR-nmPca), there is still no consensus on the optimal treatment strategy in this setting. Remarkably, the role of elective nodal irradiation (ENI) is still highly controversial. The PROspective multicenter observational study on Elective Pelvic nodes Irradiation (PRO-EPI) was designed to provide "real life" data regarding the patterns of care for IHR-nmPca. Forty-three Italian Radiation Oncology centers participated in the PROspective multicenter observational study on Elective Pelvic nodes Irradiation (PRO-EPI) project, with 1029 patients enrolled. In this preliminary analysis, we longitudinally evaluated the impact of Elective Nodal Irradiation (ENI) and radiotherapy features on toxicity and quality of life (QoL). Six months follow-up data were available for 913 patients and 12 months data for 762 patients. Elective Nodal Irradiation was given to 506 patients (48.9%). Volumetric Intensity-Modulated Radiation Therapy (IMRT) was adopted in more than 77% of patients and Image-Guided Radiation Therapy (IGRT) in 84.4%. Androgen deprivation therapy (ADT) was administered to the majority of patients (68.3%), and it was associated to ENI in 408 cases (81.1%). Toxicity was mostly mild and reversible and IGRT resulted in a significant reduction of rectal toxicity, although a non-significant trend toward increased urinary toxicity was observed. No statistically significant differences in QoL and toxicity were seen in patients treated with or without ENI. The adoption of IGRT is widespread and increasing and could reduce treatment toxicity. ENI is not yet the standard treatment, but it is performed in a growing fraction of cases and not resulting into an increase in toxicity or in a deterioration of QoL. Further analyses are needed to clarify the long-term toxicity profile and the impact of ENI on survival.
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Affiliation(s)
- Andrea Emanuele Guerini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy,*Correspondence: Andrea Emanuele Guerini,
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Gianluca Mortellaro
- Department of Radiation Oncology, Azienda ospedaliera di rilievo nazionale e di alta specializzazione (ARNAS) Ospedale Civico, Palermo, Italy
| | - Roberto Lisi
- Department of Radiotherapy, Policlinico Umberto I “Sapienza” University of Rome, Rome, Italy
| | - Alessio Bruni
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, Modena, Italy
| | - Roberto Santini
- Department of Radiation Oncology, Ospedale San Jacopo Pistoia, Pistoia, Italy
| | - Paolo Muto
- Radiotherapy, Istituto Nazionale Tumori, “Fondazione G. Pascale”-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Naples, Italy
| | - Giuseppe Ferrera
- Department of Radiation Oncology, Azienda ospedaliera di rilievo nazionale e di alta specializzazione (ARNAS) Ospedale Civico, Palermo, Italy
| | - Gianluca Cossali
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Vittorio Morelli
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | | | - Stefano Maria Magrini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Luigi Spiazzi
- Medical Physics Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, Brescia, Italy
| | - Michela Buglione
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy
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Andruska N, Fischer-Valuck BW, Waters M, Diaz EJ, Agabalogun T, Kim EH, Smith ZL, Brenneman R, Gay HA, Andriole GL, Michalski JM, Baumann BC. Survival Outcomes in Men with Unfavorable Intermediate-Risk and High-Risk Prostate Cancer Treated with Prostate-Only versus Whole Pelvic Radiation Therapy. J Urol 2022; 207:1227-1235. [PMID: 35085038 PMCID: PMC9169570 DOI: 10.1097/ju.0000000000002455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Men with unfavorable intermediate-risk (UIR-PCa) or high-risk prostate cancer (HR-PCa) are often treated with definitive external beam radiotherapy (EBRT) plus androgen deprivation therapy. Treatment is frequently intensified by electively treating the pelvic lymph nodes (LNs) with whole pelvis radiotherapy (WPRT), but practice patterns and the benefits of WPRT are not well defined. We hypothesized that men treated with WPRT would have improved overall survival (OS) relative to men treated with prostate-only radiotherapy. MATERIALS AND METHODS National Cancer Database records of men diagnosed between 2008-2015 with UIR-PCa or HR-PCa and treated with prostate EBRT±androgen deprivation therapy (72-86.4 Gy) with (15,175) or without (13,549) WPRT were reviewed. Risk of LN involvement was calculated using the Memorial Sloan Kettering Cancer Center nomogram. Measured confounders were balanced with inverse probability of treatment weighting and OS hazard ratios (HRs) were generated using multivariable Cox regression. RESULTS Of the men, 53% received WPRT. Every 1% increase in risk of LN involvement correlated with a 1% increase in risk of death (p <0.001). WPRT trended toward improved OS in all men with UIR-PCa and HR-PCa (HR: 0.95 [95% CI: 0.90-1.006], p=0.055). WPRT correlated with improved OS in men with Gleason 9 and 10 disease (HR: 0.87 [0.78-0.98], p=0.02) or risk of LN involvement ≥10% (HR: 0.93 [0.87-0.99], p=0.03). CONCLUSIONS Men with higher LN risk scores and Gleason grade benefited from WPRT. These results complement the recent POP-RT randomized trial in mostly positron emission tomography/computerized tomography-staged patients, demonstrating that a more heterogeneous population of men staged without functional imaging benefits from WPRT.
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Affiliation(s)
- Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | | | - Michael Waters
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Elizabeth Juarez Diaz
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Temitope Agabalogun
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Eric H. Kim
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Zachary L Smith
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Hiram A. Gay
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Gerald L. Andriole
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St. Louis, MO
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA
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Strnad V, Lotter M, Kreppner S, Fietkau R. Brachytherapy focal dose escalation using ultrasound based tissue characterization by patients with non-metastatic prostate cancer: Five-year results from single-center phase 2 trial. Brachytherapy 2022; 21:415-423. [PMID: 35396138 DOI: 10.1016/j.brachy.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/11/2022] [Accepted: 02/21/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE This prospective trial investigates side effects and efficacy of focal dose escalation with brachytherapy for patients with prostate cancer. METHODS AND MATERIALS In the Phase II, monocentric prospective trial 101 patients with low-/intermediate- and high-risk prostate cancer were enrolled between 2011 and 2013. Patients received either PDR-/HDR-brachytherapy alone with 86-90 Gy (EQD2, α/β = 3 Gy) or PDR-/HDR-brachytherapy as boost after external beam radiation therapy up to a total dose of 91-96 Gy (EQD2, α/β = 3 Gy). Taking place brachytherapy all patients received the simultaneous integrated focal boost to the intra-prostatic tumor lesions visible in computer-aided ultrasonography (HistoScanning™) - up to a total dose of 108-119 Gy (EQD2, α/β = 3 Gy). The primary endpoint was toxicity. Secondary endpoints were cumulative freedom from local recurrence, PSA-free survival, distant metastases-free survival, and overall survival. This trial is registered with ClinicalTrials.gov, number NCT01409876. RESULTS Median follow-up was 65 months. Late toxicity was generally low with only four patients scoring urinary grade 3 toxicity (4/101, 4%). Occurrence of any grade of late rectal toxicities was very low. We did not register any grade ≥2 of late rectal toxicities. The cumulative 5 years local recurrence rate (LRR) for all patients was 1%. Five years- biochemical disease-free survival estimates according Kaplan-Meier were 98,1% and 81,3% for low-/intermediate-risk and high-risk patients, respectively. Five years metastases-free survival estimates according Kaplan-Meier were 98,0% and 83,3% for all patients, low-/intermediate-risk and high-risk patients, respectively. CONCLUSIONS The 5 years-results from this Phase II Trial show that focal dose escalation with computer-aided ultrasonography and brachytherapy for patients with non-metastatic prostate cancer is safe and effective.
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Affiliation(s)
- Vratislav Strnad
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
| | - Michael Lotter
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Stephan Kreppner
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
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7
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Overview of the current role of stereotactic body radiotherapy in the treatment of unfavorable intermediate- and high-risk prostate cancer. JOURNAL OF RADIOSURGERY AND SBRT 2022; 8:95-103. [PMID: 36275129 PMCID: PMC9489076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/17/2022] [Indexed: 01/03/2023]
Abstract
Stereotactic body radiotherapy (SBRT) is well accepted for low- and intermediate-favorable risk prostate cancer. Available evidence about the application of SBRT in unfavorable- and high-risk prostate cancer is less solid. During last year's multiple variations in treatment, techniques have been reported making comparisons more complicated. This review's objective is to review current evidence in application of SBRT in intermediate unfavourable and high-risk prostate cancer and to outline variations in SBRT treatment techniques and relevant results.
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8
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Development of a Radiomic-Based Model Predicting Lymph Node Involvement in Prostate Cancer Patients. Cancers (Basel) 2021; 13:cancers13225672. [PMID: 34830828 PMCID: PMC8616049 DOI: 10.3390/cancers13225672] [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: 09/23/2021] [Revised: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary In patients with prostate cancer, lymph node involvement is a risk factor of relapse. Current guidelines recommend extended lymph node dissection to better stage the disease. However, such a surgical procedure is associated with a higher morbidity than limited lymph node dissection. A better selection of patients is thus essential. Radiomics features are quantitative features automatically extracted from medical imaging. Combining clinical and radiomics features, a machine learning-based model seemed to provide added predictive performance compared to state of the art models regarding the risk prediction of lymph-node involvement in prostate cancer patients. Abstract Significant advances in lymph node involvement (LNI) risk modeling in prostate cancer (PCa) have been achieved with the addition of visual interpretation of magnetic resonance imaging (MRI) data, but it is likely that quantitative analysis could further improve prediction models. In this study, we aimed to develop and internally validate a novel LNI risk prediction model based on radiomic features extracted from preoperative multimodal MRI. All patients who underwent a preoperative MRI and radical prostatectomy with extensive lymph node dissection were retrospectively included in a single institution. Patients were randomly divided into the training (60%) and testing (40%) sets. Radiomic features were extracted from the index tumor volumes, delineated on the apparent diffusion coefficient corrected map and the T2 sequences. A ComBat harmonization method was applied to account for inter-site heterogeneity. A prediction model was trained using a neural network approach (Multilayer Perceptron Network, SPSS v24.0©) combining clinical, radiomic and all features. It was then evaluated on the testing set and compared to the current available models using the Receiver Operative Characteristics and the C-Index. Two hundred and eighty patients were included, with a median age of 65.2 y (45.3–79.6), a mean PSA level of 9.5 ng/mL (1.04–63.0) and 79.6% of ISUP ≥ 2 tumors. LNI occurred in 51 patients (18.2%), with a median number of extracted nodes of 15 (10–19). In the testing set, with their respective cutoffs applied, the Partin, Roach, Yale, MSKCC, Briganti 2012 and 2017 models resulted in a C-Index of 0.71, 0.66, 0.55, 0.67, 0.65 and 0.73, respectively, while our proposed combined model resulted in a C-Index of 0.89 in the testing set. Radiomic features extracted from the preoperative MRI scans and combined with clinical features through a neural network seem to provide added predictive performance compared to state of the art models regarding LNI risk prediction in PCa.
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9
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Hannan R, Salamekh S, Desai NB, Garant A, Folkert MR, Costa DN, Mannala S, Ahn C, Mohamad O, Laine A, Kim DWN, Dickinson T, Raj GV, Shah RB, Wang J, Jia X, Choy H, Roehrborn CG, Lotan Y, Timmerman RD. SAbR for High-Risk Prostate Cancer-A Prospective Multilevel MRI-Based Dose Escalation Trial. Int J Radiat Oncol Biol Phys 2021; 113:290-301. [PMID: 34774676 DOI: 10.1016/j.ijrobp.2021.10.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/15/2021] [Accepted: 10/18/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Radiation dose intensification improves outcome in men with high-risk prostate cancer (HR-PCa). A prospective trial was conducted to determine safety, feasibility, and maximal tolerated dose of multilevel magnetic resonance imaging (MRI)-based 5-fraction SAbR in patients with HR-PCa. METHODS AND MATERIALS This phase I clinical trial enrolled patients with HR-PCa with grade group ≥4, prostate-specific antigen (PSA) ≥20 ng/mL, or radiographic ≥T3, and well-defined prostatic lesions on multiparametric MRI (mpMRI) into 4 dose-escalation cohorts. The initial cohort received 47.5 Gy to the prostate, 50 Gy to mpMRI-defined intraprostatic lesion(s), and 22.5 Gy to pelvic lymph nodes in 5 fractions. Radiation doses were escalated for pelvic nodes to 25 Gy and mpMRI lesion(s) to 52.5 Gy and then 55 Gy. Escalation was performed sequentially according to rule-based trial design with 7 to 15 patients per cohort and a 90-day observation period. All men received peri-rectal hydrogel spacer, intraprostatic fiducial placement, and 2 years of androgen deprivation. The primary endpoint was maximal tolerated dose according to a 90-day acute dose-limiting toxicity (DLT) rate <33%. DLT was defined as National Cancer Institute Common Toxicity Criteria for Adverse Events ≥grade 3 treatment-related toxicity. Secondary outcomes included acute and delayed gastrointestinal (GI)/genitourinary (GU) toxicity graded with Common Toxicity Criteria for Adverse Events. RESULTS Fifty-five of the 62 enrolled patients were included in the analysis. Dose was escalated through all 4 cohorts without observing any DLTs. Median overall follow-up was 18 months, with a median follow-up of 42, 24, 12, and 7.5 months for cohorts 1 to 4 respectively. Acute and late grade 2 GU toxicities were 25% and 20%, while GI were 13% and 7%, respectively. Late grade 3 GU and GI toxicities were 2% and 0%, respectively. CONCLUSIONS SAbR dose for HR-PCa was safely escalated with multilevel dose painting of 47.5 Gy to prostate, 55 Gy to mpMRI-defined intraprostatic lesions, and 25 Gy to pelvic nodal region in 5 fractions. Longer and ongoing follow-up will be required to assess late toxicity.
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Affiliation(s)
| | | | | | | | | | | | | | - Chul Ahn
- Population and Data Science, Comprehensive Cancer Center, University of Texas at Southwestern Medical Center, Dallas, Texas
| | - Osama Mohamad
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Aaron Laine
- The Center for Cancer and Blood Disorders, Fort Worth, Texas
| | | | | | | | | | | | - Xun Jia
- Departments of Radiation Oncology
| | - Hak Choy
- Departments of Radiation Oncology
| | | | | | - Robert D Timmerman
- Departments of Radiation Oncology; Neurosurgery, Simmons Comprehensive Cancer Center, University of Texas at Southwestern Medical Center, Dallas, Texas
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10
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Abstract
More than 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy. Clinical guidelines for the management of these patients largely focus on the use of salvage radiotherapy with or without systemic therapy. However, not all patients with biochemical recurrence will go on to develop metastases or die from their disease. The optimal pre-salvage therapy investigational workup for patients who experience biochemical recurrence should, therefore, include novel techniques such as PET imaging and genomic analysis of radical prostatectomy specimen tissue, as well as consideration of more traditional clinical variables such as PSA value, PSA kinetics, Gleason score and pathological stage of disease. In patients without metastatic disease, the only known curative intervention is salvage radiotherapy but, given the therapeutic burden of this treatment, importance must be placed on accurate timing of treatment, radiation dose, fractionation and field size. Systemic therapy also has a role in the salvage setting, both concurrently with radiotherapy and as salvage monotherapy.
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11
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De Meerleer G, Berghen C, Briganti A, Vulsteke C, Murray J, Joniau S, Leliveld AM, Cozzarini C, Decaestecker K, Rans K, Fonteyne V, De Hertogh O, Bossi A. Elective nodal radiotherapy in prostate cancer. Lancet Oncol 2021; 22:e348-e357. [PMID: 34339655 DOI: 10.1016/s1470-2045(21)00242-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022]
Abstract
In patients with prostate cancer who have a high risk of pelvic nodal disease, the use of elective whole pelvis radiotherapy is still controversial. Two large, randomised, controlled trials (RTOG 9413 and GETUG-01) did not show a benefit of elective whole pelvis radiotherapy over prostate-only radiotherapy. In 2020, the POP-RT trial established the role of elective whole pelvis radiotherapy in patients who have more than a 35% risk of lymph node invasion (known as the Roach formula). POP-RT stressed the importance of patient selection. In patients with cN1 (clinically node positive) disease or pN1 (pathologically node positive) disease, the addition of whole pelvis radiotherapy to androgen deprivation therapy significantly improved survival compared with androgen deprivation therapy alone, as shown in large, retrospective studies. This patient population might increase in the future because use of the more sensitive prostate-specific membrane antigen PET-CT will become the standard staging procedure. Additionally, the SPORTT trial suggested a benefit of whole pelvis radiotherapy in biochemical recurrence-free survival in the salvage setting. A correct definition of the upper field border, which should include the bifurcation of the abdominal aorta, is key in the use of pelvic radiotherapy. As a result of using modern radiotherapy technology, severe late urinary and intestinal toxic effects are rare and do not seem to increase compared with prostate-only radiotherapy.
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Affiliation(s)
- Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Alberto Briganti
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christof Vulsteke
- Department of Medical Oncology, Maria Middelares Hospital, Gent, Belgium
| | - Julia Murray
- Department of Radiation Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Anne M Leliveld
- Department of Urology, University Medical Centre Groningen, Groningen, Netherlands
| | - Cesare Cozzarini
- Department of Radiation Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Kato Rans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Valerie Fonteyne
- Department of Radiotherapy and Experimental Cancer Research, Gent University Hospital, Gent, Belgium
| | - Olivier De Hertogh
- Department of Radiotherapy, Centre Hospitalier Régional de Verviers, Verviers, Belgium
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Paris, France
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12
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Aizawa R, Nakamura K, Norihisa Y, Ogata T, Inoue T, Yamasaki T, Kobayashi T, Akamatsu S, Ogawa O, Mizowaki T. Long-term safety of high-dose whole pelvic IMRT for high-risk localized prostate cancer through 10-year follow-up. Int J Clin Oncol 2021; 26:2113-2122. [PMID: 34338920 DOI: 10.1007/s10147-021-02002-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the long-term efficacy and safety of whole pelvic intensity-modulated radiation therapy with a simultaneous-integrated boost (WP-SIB-IMRT) for locally advanced prostate cancer (LAPCa). METHODS All patients with cT3-4N0M0 prostate cancer treated with WP-SIB-IMRT between February 2006 and September 2009 at our institution were analyzed retrospectively. The prescribed dose was 78 Gy to the prostate and 58.5 Gy to the prophylactic pelvic lymph nodal area in 39 fractions delivered using the simultaneous-integrated boost technique. All patients received short-term neoadjuvant androgen-deprivation therapy alone (median 8.3 months). Propensity-score matching (PSM) analysis was performed to evaluate the additional benefit of prophylactic whole pelvic radiation therapy (WPRT), using the cohort of 203 LAPCa patients treated with prostate-only IMRT (PO-IMRT). RESULTS In total, 47 consecutive patients were analyzed. The median estimated risk of pelvic lymph node involvement was 57.5%. The median follow-up period was 10.5 years. The 10 year prostate cancer-specific survival and biochemical failure (BF) rates were 92.2 and 54.8%, respectively. The 10 year cumulative incidence rates of ≥ grade 2 late genitourinary and gastrointestinal toxicities were 21.6 and 17.2%, respectively. From a total of 250 patients, PSM analysis identified 76 patients with similar characteristics, and no significant difference in BF rates was observed between WP-SIB-IMRT and PO-IMRT cohorts (p = 0.261). CONCLUSIONS WP-SIB-IMRT for LAPCa was safe over long-term observation, although no clear benefit of WPRT was observed among our small and highly selected cohort. Regarding the additional efficacy of WPRT, further investigations are needed.
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Affiliation(s)
- Rihito Aizawa
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Yoshiki Norihisa
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.,Department of Radiation Oncology, Bellland General Hospital, 500-3, Higashiyama, Naka-ku, Sakai-shi, Osaka, 599-8247, Japan
| | - Takashi Ogata
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Takahiro Inoue
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.,Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi, Mie, 514-8507, Japan
| | - Toshinari Yamasaki
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.,Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
| | - Takashi Kobayashi
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Shusuke Akamatsu
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.
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Ma TM, Gafita A, Shabsovich D, Juarez J, Grogan TR, Thin P, Armstrong W, Sonni I, Nguyen K, Lok V, Reiter RE, Rettig MB, Steinberg ML, Kupelian PA, Yang DD, Muralidhar V, Chu C, Feng F, Savjani R, Deng J, Parikh NR, Nickols NG, Elashoff D, Czernin J, Calais J, Kishan AU. Identifying the Best Candidates for Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography as the Primary Staging Approach Among Men with High-risk Prostate Cancer and Negative Conventional Imaging. Eur Urol Oncol 2021; 5:100-103. [PMID: 33602654 DOI: 10.1016/j.euo.2021.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 01/25/2023]
Abstract
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) is an emerging imaging modality with greater sensitivity and specificity over conventional imaging for prostate cancer (PCa) staging. Using data from two prospective trials (NCT03368547 and NCT04050215), we explored predictors of overall upstaging (nodal and metastatic) by PSMA PET/CT among patients with cN0M0 National Comprehensive Cancer Network high-risk PCa on conventional imaging (n = 213). Overall, 21.1%, 8.9%, and 23.9% of patients experienced nodal, metastatic, and overall upstaging, respectively, without histologic confirmation. On multivariable analysis, Gleason grade group (GG) and percent positive core (PPC) on systematic biopsy significantly predict overall upstaging (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.33-3.45; p = 0.002; and OR 1.03, 95% CI 1.01-1.04; p < 0.001). Overall upstaging was significantly more frequent among men with GG 5 disease (33.0% vs. 17.6%; p = 0.0097) and PPC ≥50% (33.0% vs 15.0%; p = 0.0020). We constructed a nomogram that predicts overall upstaging using initial prostate-specific antigen, PPC, GG, and cT stage, with coefficients estimated from a standard logistic regression model (using maximum likelihood estimation). It is internally validated with a tenfold cross-validated area under the receiver operating characteristic curve estimated at 0.74 (95% CI 0.67-0.82). In our cohort, 90% of patients who had a nomogram-estimated risk below the cutoff of 22% for overall upstaging could have been spared PSMA PET/CT as our model correctly predicted no upstaging. In other words, the predictive model only missed 10% of patients who would otherwise have benefitted from PSMA PET/CT. PATIENT SUMMARY: We analyzed predictors of overall upstaging (lymph node or/and metastasis) by prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) from conventional imaging in men with high-risk prostate cancer undergoing initial staging deemed free of disease in the lymph nodes and distant metastasis by conventional imaging techniques. We found that the pathologic grade and disease burden in a prostate biopsy are associated with upstaging. We also developed a tool that predicts the probability of upstaging according to an individual patient's characteristics. Our study may help in defining patient groups who are most likely to benefit from the addition of a PSMA PET/CT scan.
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Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Andrei Gafita
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - David Shabsovich
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Jesus Juarez
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Tristan R Grogan
- Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pan Thin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Wesley Armstrong
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Ida Sonni
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Kathleen Nguyen
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Vincent Lok
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Robert E Reiter
- Department of Urology, UCLA Medical Center, Los Angeles, CA, USA
| | - Matthew B Rettig
- Department of Urology, UCLA Medical Center, Los Angeles, CA, USA; Department of Medicine, Division of Hematology-Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | | | - Patrick A Kupelian
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - David D Yang
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA
| | - Vinayak Muralidhar
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA
| | - Carissa Chu
- Department of Urology, UCSF Medical Center, San Francisco, CA, USA
| | - Felix Feng
- Department of Urology, UCSF Medical Center, San Francisco, CA, USA; Department of Radiation Oncology, UCSF Medical Center, San Francisco, CA, USA
| | - Ricky Savjani
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Jie Deng
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Neil R Parikh
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Nicholas G Nickols
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - David Elashoff
- Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Amar U Kishan
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA.
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14
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Luo HC, Fu ZC, Wang XP, Cai LJ, Wang FM, Yin Q, Lin G, Chen ZH, Liao SG. Treating the primary in low burden metastatic prostate cancer: Where do we stand? Medicine (Baltimore) 2020; 99:e23715. [PMID: 33371121 PMCID: PMC7748322 DOI: 10.1097/md.0000000000023715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022] Open
Abstract
On the basis of endocrine therapy for patients with low burden metastatic prostate cancer (LBMP), the clinical efficacy and quality of life were compared between prostate-only directed radiotherapy (PODT) and prostate and metastasis radiotherapy (PMRT).From November 2009 to November 2015, total 91 patients newly diagnosed with LBMP were retrospectively analyzed, of which 52 patients received PODT and 39 patients received PMRT. The biochemical failure free interval (IBF), prostate specific survival (PCSS), and overall survival (OS) time were compared between the 2 groups, and expanded prostate cancer index composite (EPIC) scale was used to evaluate the difference in quality of life between the 2 groups.The median IBF of the PODT group was 31 months, which was significantly lower than the 39 months of the PMRT group (P < .05); the 5-year OS and PCSS were 58.9%, 65.3% in PODT group, and 58.9%, 71.79% in PMRT group, respectively. There was no significant between the 2 groups (P > .05); the side effects of acute radiotherapy in PMRT group were significantly higher than PODT group (P < .05), especially in bone marrow suppression and gastrointestinal reactions; The scores of urinary system function and intestinal system function in PMRT group were significantly higher than PODT group at the end of radiotherapy, 3 months after radiotherapy, and 6 months after radiotherapy (P < .05). The score of sexual function in PMRT group was significantly lower than that in PODT group after radiotherapy (P < .05), and higher than that in PORT group at other follow-up time points (P < .05). The hormone function was decreased at each follow-up time point in 2 groups, and there was no significant difference between the 2 groups (P > .05).Patients with LBMP receiving PMRT can improve IBF, but cannot increase PCSS and OS, and increase the incidence of acute radiation injury.
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Affiliation(s)
| | | | | | | | - Feng-Mei Wang
- Department of Gynaecology and Obstetrics, The 900th Hospital of Joint Logistics Force (Xiamen Dongfang Hospital), Fuzhou
| | - Qin Yin
- Department of Oncology, Longyan People's Hospital, Longyan
| | - Guishan Lin
- Department of Radiation Oncology, Fujian Province's Hospital, Fujian
| | | | - Shao-Guang Liao
- Department of Oncology, Taizhou First People's Hospital (Huangyan Hospital, Wenzhou Medical University), Taizhou, Zhejiang, China
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15
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Taussky D, Delouya G. Is pelvic prophylactic radiotherapy in prostate cancer just right? Transl Androl Urol 2020; 9:2296-2298. [PMID: 33209698 PMCID: PMC7658169 DOI: 10.21037/tau-20-881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Daniel Taussky
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), Canada
| | - Guila Delouya
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), Canada
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16
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Li YR, Roach M. The Roach Equation: Value of Old Clinical Tools in the Era of New Molecular Imaging. J Nucl Med 2020; 61:1292-1293. [PMID: 32444373 DOI: 10.2967/jnumed.120.246736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yun Rose Li
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Mack Roach
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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Moris L, Cumberbatch MG, Van den Broeck T, Gandaglia G, Fossati N, Kelly B, Pal R, Briers E, Cornford P, De Santis M, Fanti S, Gillessen S, Grummet JP, Henry AM, Lam TBL, Lardas M, Liew M, Mason MD, Omar MI, Rouvière O, Schoots IG, Tilki D, van den Bergh RCN, van Der Kwast TH, van Der Poel HG, Willemse PPM, Yuan CY, Konety B, Dorff T, Jain S, Mottet N, Wiegel T. Benefits and Risks of Primary Treatments for High-risk Localized and Locally Advanced Prostate Cancer: An International Multidisciplinary Systematic Review. Eur Urol 2020; 77:614-627. [PMID: 32146018 DOI: 10.1016/j.eururo.2020.01.033] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
CONTEXT The optimal treatment for men with high-risk localized or locally advanced prostate cancer (PCa) remains unknown. OBJECTIVE To perform a systematic review of the existing literature on the effectiveness of the different primary treatment modalities for high-risk localized and locally advanced PCa. The primary oncological outcome is the development of distant metastases at ≥5 yr of follow-up. Secondary oncological outcomes are PCa-specific mortality, overall mortality, biochemical recurrence, and need for salvage treatment with ≥5 yr of follow-up. Nononcological outcomes are quality of life (QoL), functional outcomes, and treatment-related side effects reported. EVIDENCE ACQUISITION Medline, Medline In-Process, Embase, and the Cochrane Central Register of Randomized Controlled Trials were searched. All comparative (randomized and nonrandomized) studies published between January 2000 and May 2019 with at least 50 participants in each arm were included. Studies reporting on high-risk localized PCa (International Society of Urologic Pathologists [ISUP] grade 4-5 [Gleason score {GS} 8-10] or prostate-specific antigen [PSA] >20 ng/ml or ≥ cT2c) and/or locally advanced PCa (any PSA, cT3-4 or cN+, any ISUP grade/GS) or where subanalyses were performed on either group were included. The following primary local treatments were mandated: radical prostatectomy (RP), external beam radiotherapy (EBRT) (≥64 Gy), brachytherapy (BT), or multimodality treatment combining any of the local treatments above (±any systemic treatment). Risk of bias (RoB) and confounding factors were assessed for each study. A narrative synthesis was performed. EVIDENCE SYNTHESIS Overall, 90 studies met the inclusion criteria. RoB and confounding factors revealed high RoB for selection, performance, and detection bias, and low RoB for correction of initial PSA and biopsy GS. When comparing RP with EBRT, retrospective series suggested an advantage for RP, although with a low level of evidence. Both RT and RP should be seen as part of a multimodal treatment plan with possible addition of (postoperative) RT and/or androgen deprivation therapy (ADT), respectively. High levels of evidence exist for EBRT treatment, with several randomized clinical trials showing superior outcome for adding long-term ADT or BT to EBRT. No clear cutoff can be proposed for RT dose, but higher RT doses by means of dose escalation schemes result in an improved biochemical control. Twenty studies reported data on QoL, with RP resulting mainly in genitourinary toxicity and sexual dysfunction, and EBRT in bowel problems. CONCLUSIONS Based on the results of this systematic review, both RP as part of multimodal treatment and EBRT + long-term ADT can be recommended as primary treatment in high-risk and locally advanced PCa. For high-risk PCa, EBRT + BT can also be offered despite more grade 3 toxicity. Interestingly, for selected patients, for example, those with higher comorbidity, a shorter duration of ADT might be an option. For locally advanced PCa, EBRT + BT shows promising result but still needs further validation. In this setting, it is important that patients are aware that the offered therapy will most likely be in the context a multimodality treatment plan. In particular, if radiation is used, the combination of local with systemic treatment provides the best outcome, provided the patient is fit enough to receive both. Until the results of the SPCG15 trial are known, the optimal local treatment remains a matter of debate. Patients should at all times be fully informed about all available options, and the likelihood of a multimodal approach including the potential side effects of both local and systemic treatment. PATIENT SUMMARY We reviewed the literature to see whether the evidence from clinical studies would tell us the best way of curing men with aggressive prostate cancer that had not spread to other parts of the body such as lymph glands or bones. Based on the results of this systematic review, there is good evidence that both surgery and radiation therapy are good treatment options, in terms of prolonging life and preserving quality of life, provided they are combined with other treatments. In the case of surgery this means including radiotherapy (RT), and in the case of RT this means either hormonal therapy or combined RT and brachytherapy.
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Affiliation(s)
- Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium.
| | | | | | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Brian Kelly
- Department of Urology, Austin Health, Heidelberg, VIC, Australia
| | - Raj Pal
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | | | - Philip Cornford
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Maria De Santis
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Italy
| | - Silke Gillessen
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, University of Bern, Bern, Switzerland; Division of Cancer Sciences, University of Manchester and The Christie, Manchester, UK
| | - Jeremy P Grummet
- Department of Surgery, Central Clinical School, Monash University, Australia
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Thomas B L Lam
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK; Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Matthew Liew
- Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Malcolm D Mason
- Division of Cancer & Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK
| | | | - Olivier Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France; Faculté de Médecine Lyon Est, Université Lyon 1, Université de Lyon, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Henk G van Der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Peter-Paul M Willemse
- Department of Oncological Urology, University Medical Center, Utrecht Cancer Center, Utrecht, The Netherlands
| | - Cathy Y Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | | | - Tanya Dorff
- Department of Medical Oncology and Developmental Therapeutics, City of Hope, Duarte, CA, USA; Department of Medicine, University of Southern California (USC) Keck School of Medicine and Norris Comprehensive Cancer Center (NCCC), Los Angeles, CA, USA
| | - Suneil Jain
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK; Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
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Chen RC. Randomized Trials and the Goldilocks Problem. Eur Urol 2020; 77:11-13. [PMID: 31103392 DOI: 10.1016/j.eururo.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Ronald C Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
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