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Zimmermann JS, Osieka R, Bruns T, Hollberg H, Wiechmann B, Netzbandt O, Sablotny J, Malade M, Heitz M, Bernhardt F, Tiemann J, Wilkens M, Brüske T, Welker U, Heinemann V, Zimmermann P, de la Maza SF, Pfeiffer D, Tauber PR, Thomas D, Moustakis C. Five-year effectiveness of low-dose-rate brachytherapy: comparisons with nomogram predictions in patients with non-metastatic prostate cancer presenting significant control of intra- and periprostatic disease. J Contemp Brachytherapy 2018; 10:297-305. [PMID: 30237813 PMCID: PMC6142645 DOI: 10.5114/jcb.2018.77949] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/24/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess the effectiveness of low-dose-rate (LDR) brachytherapy in patients with localized prostate cancer and to compare the outcome with predictions from Kattan and Partin nomograms at 60 months after seed implantation. MATERIAL AND METHODS One thousand, one hundred and eighty-seven patients with localized prostate cancer at low-, intermediate-, or high-risk of progression received LDR brachytherapy using iodine-125 seeds with curative intent, applied as monotherapy or in combination with external beam radiation therapy (EBRT), and/or androgen deprivation therapy (ADT). At 60 months after seed implantation, data of 1,064 patients (1,058 alive + 6 who died of prostate cancer) were analyzed for biochemical progression-free survival (bPFS) based on prostate-specific antigen (PSA) levels using the Phoenix definition. Five-year bPFS probabilities were determined for various risk group classifications (d'Amico, Mt. Sinai, MSKCC/Seattle, NCCN). Outcomes were also compared to patient-individualized nomogram predictions of 5-year bPFS (Kattan 2002) and probability of organ-confined disease (Kattan 2002, Partin 2007). RESULTS Overall, 93.3% (993/1,064) of the patients were free of biochemical progression within 5 years, while the average 5-year bPFS probability according to the Kattan nomogram was significantly lower (85%, p < 0.001). Outcomes were significantly better than Kattan nomogram predictions in the subgroup of patients with monotherapy as well as in patients additionally treated with EBRT. Comparison of the overall outcome with nomogram predictions for organ-confined disease (Kattan nomogram: 50%; Partin nomogram: 65%) revealed a significant probability of LDR brachytherapy to destroy periprostatic tumor spread (p < 0.001) in all risk group constellations, even in high-risk patients. CONCLUSIONS The results indicate high effectiveness of LDR brachytherapy in all risk groups, significantly better than predicted with the Kattan nomogram in most subgroups. The significant superiority of LDR brachytherapy compared to nomogram predictions of organ-confined disease suggests that LDR brachytherapy effectively controls both intra- and periprostatic disease.
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Affiliation(s)
- Jörg S Zimmermann
- Praxis für Brachytherapie, Praxiszentrum Alstertal, Hamburg
- Katholisches Marienkrankenhaus, Hamburg
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- Praxis für Brachytherapie, Praxiszentrum Alstertal, Hamburg
- Katholisches Marienkrankenhaus, Hamburg
| | - Christos Moustakis
- Praxis für Brachytherapie, Praxiszentrum Alstertal, Hamburg
- Katholisches Marienkrankenhaus, Hamburg
- Klinik für Strahlentherapie, Abteilung Medizinische Physik, Universitätsklinik Münster, Germany
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Caulfield S, Menezes G, Marignol L, Poole C. Nomograms are key decision-making tools in prostate cancer radiation therapy. Urol Oncol 2018; 36:283-292. [PMID: 29680180 DOI: 10.1016/j.urolonc.2018.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/16/2018] [Accepted: 03/22/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The use of nomograms for predicting clinical endpoints has been well documented. Nomograms provide an individualized prognosis and help clinicians determine the effectiveness of treatment for a given patient. Early identification of potential treatment failure or toxicity allows alternative approaches to be considered, reducing unnecessary treatment, morbidity, and cost. This review aims to evaluate clinical potential of nomogram use for the management of prostate cancer radiotherapy patients. METHODS PubMed, Embase, and Scopus were searched for literature published between 2006 and 2016. The reported correlation between measured and nomogram-predicted probabilities of biochemical control, disease progression, survival and toxicity was reviewed, through an analysis of concordance indexes and areas under the curves. RESULTS Sixteen studies were reviewed. Outcomes predicted by the nomogram were very close to outcomes measured (concordance index of 0.7 and above) in the majority. But a combination of under and overestimation of outcome was also reported. The predictive accuracy of nomograms was very variable, however, most nomograms had accuracy greater than chance, indicated by a concordance index higher than 0.5. CONCLUSION Nomograms can be used as prognostic guides to aid clinical decision-making for prostate cancer patients until further research addresses the limitations presented in this review. Strict definitions of end points should be added to future models and perhaps models could be enhanced with the incorporation of genomic variables or tumor specific parameters.
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Affiliation(s)
- Sarah Caulfield
- Trinity College Dublin, Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Dublin, Ireland
| | - Gerard Menezes
- Trinity College Dublin, Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Dublin, Ireland
| | - Laure Marignol
- Trinity College Dublin, Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Dublin, Ireland
| | - Claire Poole
- Trinity College Dublin, Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Dublin, Ireland.
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Parameters predicting for prostate specific antigen response rates at one year post low-dose-rate intraoperative prostate brachytherapy. J Contemp Brachytherapy 2017; 9:99-105. [PMID: 28533796 PMCID: PMC5437084 DOI: 10.5114/jcb.2017.67198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/04/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To develop a model for prostate specific antigen (PSA) values at one year among patients treated with intraoperatively planned 125I prostate brachytherapy (IOPB). Material and methods Four hundred and deven patients treated with IOPB for prostate adenocarcinoma were divided into four groups: those with PSA values ≥ 3 ng/ml; < 3 and ≥ 2; < 2 and ≥ 1 or PSA < 1 between 10.5 and 14.5 months post implantation (1yPSA). Ordinal regression analysis was then performed between patient, tumor, and treatment characteristics. 1yPSA values were also compared with toxicity outcomes. Results Median 1yPSA was 0.77 (0.04-17.36). Thirty-two patients (8%) had a PSA ≥ 3; 35 (9%) had PSA < 3, ≥ 2; 87 (21%) had PSA < 2, ≥ 1, and most patients 254 (62%) had PSA < 1. PSA response was independent of gland volume, Gleason score, clinical stage, seed activity, V90, V200, D90, or number of needles and seeds used. Older patients had significantly lower 1yPSA; median ages 65.1 (46.5-81.0), 62.1 (50.4-79.5), 60.5 (47.1-80.3), and 58.1 (45.1-74.2) years for each of the 1yPSA groups respectively (p < 0.001). Also, both implant V150 (p < 0.001) and initial PSA values (p = 0.04) were predictive of 1yPSA values. There was no correlation between 1yPSA values and toxicity encountered. Conclusions PSA response at 1 year post IOPB appears to be dependent on patient age, initial PSA, and implant V150. Our results provide reassurance that parameters other than biochemical failure influence 1yPSA values.
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Raymond E, O'Callaghan ME, Campbell J, Vincent AD, Beckmann K, Roder D, Evans S, McNeil J, Millar J, Zalcberg J, Borg M, Moretti K. An appraisal of analytical tools used in predicting clinical outcomes following radiation therapy treatment of men with prostate cancer: a systematic review. Radiat Oncol 2017; 12:56. [PMID: 28327203 PMCID: PMC5359887 DOI: 10.1186/s13014-017-0786-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Prostate cancer can be treated with several different modalities, including radiation treatment. Various prognostic tools have been developed to aid decision making by providing estimates of the probability of different outcomes. Such tools have been demonstrated to have better prognostic accuracy than clinical judgment alone. Methods A systematic review was undertaken to identify papers relating to the prediction of clinical outcomes (biochemical failure, metastasis, survival) in patients with prostate cancer who received radiation treatment, with the particular aim of identifying whether published tools are adequately developed, validated, and provide accurate predictions. PubMed and EMBASE were searched from July 2007. Title and abstract screening, full text review, and critical appraisal were conducted by two reviewers. A review protocol was published in advance of commencing literature searches. Results The search strategy resulted in 165 potential articles, of which 72 were selected for full text review and 47 ultimately included. These papers described 66 models which were newly developed and 31 which were external validations of already published predictive tools. The included studies represented a total of 60,457 patients, recruited between 1984 and 2009. Sixty five percent of models were not externally validated, 57% did not report accuracy and 31% included variables which are not readily accessible in existing datasets. Most models (72, 74%) related to external beam radiation therapy with the remainder relating to brachytherapy (alone or in combination with external beam radiation therapy). Conclusions A large number of prognostic models (97) have been described in the recent literature, representing a rapid increase since previous reviews (17 papers, 1966–2007). Most models described were not validated and a third utilised variables which are not readily accessible in existing data collections. Where validation had occurred, it was often limited to data taken from single institutes in the US. While validated and accurate models are available to predict prostate cancer specific mortality following external beam radiation therapy, there is a scarcity of such tools relating to brachytherapy. This review provides an accessible catalogue of predictive tools for current use and which should be prioritised for future validation. Electronic supplementary material The online version of this article (doi:10.1186/s13014-017-0786-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elspeth Raymond
- South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), Adelaide, Australia
| | - Michael E O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), Adelaide, Australia. .,Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia. .,SA Health, Repatriation General Hospital, Urology Unit, Daws Road, Daw Park, 5041, SA, Australia. .,Flinders Centre for Innovation in Cancer, Bedford Park, Australia.
| | - Jared Campbell
- Joanna Briggs Institute, University of Adelaide, Adelaide, Australia
| | - Andrew D Vincent
- South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), Adelaide, Australia.,Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia
| | - Kerri Beckmann
- South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), Adelaide, Australia.,Centre for Population Health Research, University of South Australia, Adelaide, Australia
| | - David Roder
- Centre for Population Health Research, University of South Australia, Adelaide, Australia
| | - Sue Evans
- Epidemiology & Preventative Medicine, Monash University, Clayton, Australia
| | - John McNeil
- Epidemiology & Preventative Medicine, Monash University, Clayton, Australia
| | - Jeremy Millar
- Radiation Oncology, Alfred Health, Melbourne, Australia
| | - John Zalcberg
- Epidemiology & Preventative Medicine, Monash University, Clayton, Australia.,School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Martin Borg
- Adelaide Radiotherapy Centre, Adelaide, Australia
| | - Kim Moretti
- South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), Adelaide, Australia.,Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia.,Centre for Population Health Research, University of South Australia, Adelaide, Australia.,Joanna Briggs Institute, University of Adelaide, Adelaide, Australia.,Discipline of Surgery, University of Adelaide, Adelaide, Australia
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