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Jackson WC, Desai NB, Abugharib AE, Tumati V, Dess RT, Lee JY, Zhao SG, Soliman M, Folkert M, Laine A, Hannan R, Zumsteg ZS, Sandler H, Hamstra DA, Montgomery JS, Miller DC, Kozminski MA, Hollenbeck BK, Hearn JW, Palapattu G, Tomlins SA, Mehra R, Morgan TM, Feng FY, Spratt DE. Anatomical patterns of recurrence following biochemical relapse after post-prostatectomy salvage radiation therapy: a multi-institutional study. BJU Int 2017; 120:351-357. [PMID: 28139024 DOI: 10.1111/bju.13792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To characterise the frequency and detailed anatomical sites of failure for patients receiving post-radical prostatectomy (RP) salvage radiation therapy (SRT). PATIENTS AND METHODS A multi-institutional retrospective study was performed on 574 men who underwent SRT between 1986 and 2013. Anatomical recurrence patterns were classified as lymphotrophic (lymph nodes only), osteotrophic (bone only), or multifocal if both were present. Isolated first failure sites were defined as sites of initial clinically detected recurrence that remained isolated for at least 3 months. RESULTS The median follow-up after SRT was 6.8 years. The 8-year rates of local, regional, and distant failure for patients undergoing SRT were 2%, 6%, and 21%, respectively. Of the 22% men (128 of 574) who developed a clinically detectable recurrence, 17%, 50%, and 31% were lymphotrophic, osteotrophic, and multifocal, respectively. The trophic nature of metastases was prognostic for distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS); the 10-year rates of DMFS were 18%, 5%, and 7% (P < 0.01), and PCSS were 78%, 68%, and 56% (P < 0.01), for lymphotrophic, osteotrophic, and multifocal failure patterns, respectively. CONCLUSIONS We demonstrate that trophism for metastatic site has significant prognostic impact on PCSS in men treated with SRT. Radiographic local failure is an uncommon event after SRT when compared to historical data of patients treated with surgery monotherapy. However, distant failure remains a challenge in this patient population and warrants further therapeutic investigation.
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Affiliation(s)
- William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Ahmed E Abugharib
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Vasu Tumati
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jae Y Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Shuang G Zhao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Moaaz Soliman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Michael Folkert
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Aaron Laine
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Howard Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Mike A Kozminski
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Jason W Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Ganesh Palapattu
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Scott A Tomlins
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
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Jackson WC, Feng FY, Daignault S, Hussain M, Smith D, Cooney K, Pienta K, Jolly S, Hollenbeck B, Olson KB, Sandler HM, Ray ME, Hamstra DA. A phase 2 trial of salvage radiation and concurrent weekly docetaxel after a rising prostate-specific antigen level after radical prostatectomy. Adv Radiat Oncol 2016; 1:59-66. [PMID: 28799570 PMCID: PMC5506748 DOI: 10.1016/j.adro.2015.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 10/24/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE/OBJECTIVES We sought to assess the utility of docetaxel administered concurrently with salvage radiation therapy (SRT) following postprostatectomy biochemical failure (BF). METHODS AND MATERIALS Men with postprostatectomy BF were accrued on a single-arm phase 2 clinical trial. SRT doses ranged from 64.8 to 70.2 Gy and were delivered in 1.8-Gy fractions to the prostate bed alone as the clinical target volume with a +1-cm uniform planning target volume expansion. The primary endpoint was progression-free survival at 4 years compared with the Stephenson nomogram estimate. Kaplan-Meier methods were used to assess late toxicity, BF, and distant metastases. An unplanned matched-pair analysis was performed with 19 patients treated with SRT alone. RESULTS Nineteen men were accrued and treated. Median follow-up was 4.8 years. Median pre-RT prostate-specific antigen level was 0.7 ng/mL (interquartile range, 0.4-1.3 ng/mL). All 8 cycles of docetaxel were completed in 17 (89%) patients. Acute grade 1-4 toxicities were observed in 79%, 50%, 58%, and 11%, respectively. A total of 68% of acute grade 1 toxicities were related to fatigue, urinary, or bowel symptoms. For grade 2 toxicities, 76% were related to neutropenia, fatigue, or urinary symptoms. Acute grade 3 and 4 toxicities were most commonly neutropenia (84% and 100%, respectively). All late toxicities were grade 1 to 2 with 89% related to bowel or urinary function. Predicted 4-year progression-free survival was 39% and observed was 42% (90% confidence interval [CI], 24-60). Matched-pair analysis demonstrated no significant improvement in BF (P = .96, hazard ratio, 0.98; 90% CI, 0.4-2.3) or distant metastases (P = .09; hazard ratio, 0.3; 90% CI, 0.07-1.2), and no difference between late bowel (P = .60) or urinary toxicity (P = .41). CONCLUSIONS Docetaxel can safely be administered concurrently with SRT without significantly impacting posttreatment toxicity. Neutropenia was the most significant acute toxicity. Given the small sample size, no clear clinical benefit was observed. Larger studies are needed to determine the efficacy of concurrent docetaxel in this setting.
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Affiliation(s)
- William C. Jackson
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Felix Y. Feng
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Stephanie Daignault
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Maha Hussain
- University of Michigan Department of Hematology/Oncology, Ann Arbor, Michigan
| | - David Smith
- University of Michigan Department of Hematology/Oncology, Ann Arbor, Michigan
| | - Kathleen Cooney
- University of Michigan Department of Hematology/Oncology, Ann Arbor, Michigan
| | - Kenneth Pienta
- Johns Hopkins James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Shruti Jolly
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
| | - Brent Hollenbeck
- University of Michigan Department of Urology, Ann Arbor, Michigan
| | - Karin B. Olson
- Eastern Michigan University Physician Assistant Program, Ypsilanti, Michigan
| | - Howard M. Sandler
- Cedars Sinai Department of Radiation Oncology, Los Angeles, California
| | | | - Daniel A. Hamstra
- University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan
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