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Mazzeo E, Triggiani L, Frassinelli L, Guarneri A, Bartoncini S, Antognoni P, Gottardo S, Greco D, Borghesi S, Nanni S, Bruni A, Ingrosso G, D’Angelillo RM, Detti B, Francolini G, Magli A, Guerini AE, Arcangeli S, Spiazzi L, Ricardi U, Lohr F, Magrini SM. How Has Prostate Cancer Radiotherapy Changed in Italy between 2004 and 2011? An Analysis of the National Patterns-Of-Practice (POP) Database by the Uro-Oncology Study Group of the Italian Society of Radiotherapy and Clinical Oncology (AIRO). Cancers (Basel) 2021; 13:cancers13112702. [PMID: 34070797 PMCID: PMC8199007 DOI: 10.3390/cancers13112702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary This is a safety and efficacy analysis from a very large dataset of patients affected by localized prostate cancer having received radiotherapy with or without concomitant androgen deprivation therapy in twelve academic and non-academic Italian Institutions. The aim of this retrospective "real life" study was to provide additional data on clinical presentation, diagnostic workup, radiation therapy management and toxicity as collected within the framework of POP III. Though the usual limitations for a retrospective analysis apply, it nevertheless may expand the current knowledge in this area showing the progress of radiation therapy techniques and clinical outcomes in the period between 2004 and 2011 after a significant period of follow up. Abstract Background and purpose: Two previous “Patterns Of Practice” surveys (POP I and POP II), including more than 4000 patients affected by prostate cancer treated with radical external beam radiotherapy (EBRT) between 1980 and 2003, established a “benchmark” Italian data source for prostate cancer radiotherapy. This report (POP III) updates the previous studies. Methods: Data on clinical management and outcome of 2525 prostate cancer patients treated by EBRT from 2004 to 2011 were collected and compared with POP II and, when feasible, also with POP I. This report provides data on clinical presentation, diagnostic workup, radiation therapy management, and toxicity as collected within the framework of POP III. Results: More than 50% of POP III patients were classified as low or intermediate risk using D’Amico risk categories as in POP II; 46% were classified as ISUP grade group 1. CT scan, bone scan, and endorectal ultrasound were less frequently prescribed. Dose-escalated radiotherapy (RT), intensity modulated radiotherapy (IMRT), image guided radiotherapy (IGRT), and hypofractionated RT were more frequently offered during the study period. Treatment was commonly well tolerated. Acute toxicity improved compared to the previous series; late toxicity was influenced by prescribed dose and treatment technique. Five-year overall survival, biochemical relapse free survival (BRFS), and disease specific survival were similar to those of the previous series (POP II). BRFS was better in intermediate- and high-risk patients treated with ≥ 76 Gy. Conclusions: This report highlights the improvements in radiotherapy planning and dose delivery among Italian Centers in the 2004–2011 period. Dose-escalated treatments resulted in better biochemical control with a reduction in acute toxicity and higher but acceptable late toxicity, as not yet comprehensively associated with IMRT/IGRT. CTV-PTV margins >8 mm were associated with increased toxicity, again suggesting that IGRT—allowing for tighter margins—would reduce toxicity for dose escalated RT. These conclusions confirm the data obtained from randomized controlled studies.
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Affiliation(s)
- Ercole Mazzeo
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41124 Modena, Italy; (E.M.); (L.F.); (F.L.)
| | - Luca Triggiani
- Radiation Oncology Department, University and Spedali Civili Hospital, 25123 Brescia, Italy; (L.T.); (D.G.); (A.E.G.); (S.M.M.)
| | - Luca Frassinelli
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41124 Modena, Italy; (E.M.); (L.F.); (F.L.)
| | - Alessia Guarneri
- Department of Oncology, Radiation Oncology, Azienda Ospedaliero-Universitaria Città della Salute e Della Scienza, 10126 Turin, Italy; (A.G.); (S.B.)
| | - Sara Bartoncini
- Department of Oncology, Radiation Oncology, Azienda Ospedaliero-Universitaria Città della Salute e Della Scienza, 10126 Turin, Italy; (A.G.); (S.B.)
| | - Paolo Antognoni
- Radiotherapy Deparment, ASST dei Sette Laghi-Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy;
| | - Stefania Gottardo
- Service of Radiotherapy, Istituito Clinico Sant’Ambrogio, 25123 Milan, Italy;
| | - Diana Greco
- Radiation Oncology Department, University and Spedali Civili Hospital, 25123 Brescia, Italy; (L.T.); (D.G.); (A.E.G.); (S.M.M.)
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, 52100 Arezzo, Italy; (S.B.); (S.N.)
| | - Sara Nanni
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, 52100 Arezzo, Italy; (S.B.); (S.N.)
| | - Alessio Bruni
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41124 Modena, Italy; (E.M.); (L.F.); (F.L.)
- Correspondence:
| | - Gianluca Ingrosso
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | | | - Beatrice Detti
- Unit of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (B.D.); (G.F.)
| | - Giulio Francolini
- Unit of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (B.D.); (G.F.)
| | - Alessandro Magli
- Department of Radiation Oncology, Udine General Hospital, 33100 Udine, Italy;
| | - Andrea Emanuele Guerini
- Radiation Oncology Department, University and Spedali Civili Hospital, 25123 Brescia, Italy; (L.T.); (D.G.); (A.E.G.); (S.M.M.)
| | - Stefano Arcangeli
- Department of Radiation Oncology, S. Gerardo Hospital—University of Milan Bicocca, 20900 Monza, Italy;
| | - Luigi Spiazzi
- Department of Medical Physics, Spedali Civili Hospital, 25123 Brescia, Italy;
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, 10126 Turin, Italy;
| | - Frank Lohr
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41124 Modena, Italy; (E.M.); (L.F.); (F.L.)
| | - Stefano Maria Magrini
- Radiation Oncology Department, University and Spedali Civili Hospital, 25123 Brescia, Italy; (L.T.); (D.G.); (A.E.G.); (S.M.M.)
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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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Madhu P, Reddy KP, Reddy PS. Role of melatonin in mitigating chemotherapy-induced testicular dysfunction in Wistar rats. Drug Chem Toxicol 2015; 39:137-46. [PMID: 26072956 DOI: 10.3109/01480545.2015.1055359] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Testicular cancer is the most common cancer affecting men of reproductive age, and its incidence is increasing steadily. A regimen of cisplatin (P), vinblastin (V) and bleomycin (B) (PVB) is the standard chemotherapy for testicular cancer. Though PVB-based chemotherapy has been widely used against germ cell tumors, it is associated with induction of oxidative toxicity and a transient or permanent loss of fertility. However, the mechanism of action of PVB on the testis is not thoroughly elucidated. Using a rat model, we investigated the persistence of the effects of PVB on steroidogenesis, spermatogenesis and testicular oxidative status and architecture. Further, we have also studied whether administration of melatonin has any protective effect on testicular physiology in the PVB-treated rats, since melatonin exerts influence on the antioxidant defense system. The body weight of the PVB-treated rats did not show significant change as compared with the control group. Significant decrease in the weight of the testis was observed with a reduction in volume in the PVB-treated rats. Administration of PVB caused a reduction in the testicular steroidogenesis and spermatogenesis. The circulatory levels of testosterone were also significantly reduced with an elevation of FSH and LH in the PVB-treated rats. Testicular architecture was severely affected with a reduction in seminiferous tubule diameter and epithelial height. The activities of superoxide dismutase and catalase were decreased while the levels of lipid peroxidation increased significantly in the testis of the PVB-treated rats indicating depletion of antioxidant defence system and elevation of oxidative stress. Co-administration of melatonin mitigated these changes in the PVB-treated rats.
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Affiliation(s)
- P Madhu
- a Department of Biotechnology and.,b Department of Zoology , Sri Venkateswara University , Tirupati , Andhra Pradesh , India
| | - K Pratap Reddy
- a Department of Biotechnology and.,b Department of Zoology , Sri Venkateswara University , Tirupati , Andhra Pradesh , India
| | - P Sreenivasula Reddy
- b Department of Zoology , Sri Venkateswara University , Tirupati , Andhra Pradesh , India
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Panje CM, Dal Pra A, Zilli T, R Zwahlen D, Papachristofilou A, Herrera FG, Matzinger O, Plasswilm L, Putora PM. Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland: A survey on patterns of practice. Strahlenther Onkol 2015; 191:778-86. [PMID: 25986251 DOI: 10.1007/s00066-015-0849-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/22/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION External beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), is an established treatment option for nonmetastatic prostate cancer. Despite high-level evidence from several randomized trials, risk group stratification and treatment recommendations vary due to contradictory or inconclusive data, particularly with regard to EBRT dose prescription and ADT duration. Our aim was to investigate current patterns of practice in primary EBRT for prostate cancer in Switzerland. MATERIALS AND METHODS Treatment recommendations on EBRT and ADT for localized and locally advanced prostate cancer were collected from 23 Swiss radiation oncology centers. Written recommendations were converted into center-specific decision trees, and analyzed for consensus and differences using a dedicated software tool. Additionally, specific radiotherapy planning and delivery techniques from the participating centers were assessed. RESULTS The most commonly prescribed radiation dose was 78 Gy (range 70-80 Gy) across all risk groups. ADT was recommended for intermediate-risk patients for 6 months in over 80 % of the centers, and for high-risk patients for 2 or 3 years in over 90 % of centers. For recommendations on combined EBRT and ADT treatment, consensus levels did not exceed 39 % in any clinical scenario. Arc-based intensity-modulated radiotherapy (IMRT) is implemented for routine prostate cancer radiotherapy by 96 % of the centers. CONCLUSION Among Swiss radiation oncology centers, considerable ranges of radiotherapy dose and ADT duration are routinely offered for localized and locally advanced prostate cancer. In the vast majority of cases, doses and durations are within the range of those described in current evidence-based guidelines.
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Affiliation(s)
- Cédric M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Department of Radiation Oncology, Universitätsspital Zürich, Zurich, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Inselspital Bern, Bern, Switzerland
| | - Thomas Zilli
- Department of Radiation Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | | | - Fernanda G Herrera
- Department of Radiation Oncology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - Oscar Matzinger
- Department of Radiation Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland
| | - Ludwig Plasswilm
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
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De Bari B, Vallati M, Gatta R, Simeone C, Girelli G, Ricardi U, Meattini I, Gabriele P, Bellavita R, Krengli M, Cafaro I, Cagna E, Bunkheila F, Borghesi S, Signor M, Di Marco A, Bertoni F, Stefanacci M, Pasinetti N, Buglione M, Magrini SM. Could machine learning improve the prediction of pelvic nodal status of prostate cancer patients? Preliminary results of a pilot study. Cancer Invest 2015; 33:232-40. [PMID: 25950849 DOI: 10.3109/07357907.2015.1024317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We tested and compared performances of Roach formula, Partin tables and of three Machine Learning (ML) based algorithms based on decision trees in identifying N+ prostate cancer (PC). 1,555 cN0 and 50 cN+ PC were analyzed. Results were also verified on an independent population of 204 operated cN0 patients, with a known pN status (187 pN0, 17 pN1 patients). ML performed better, also when tested on the surgical population, with accuracy, specificity, and sensitivity ranging between 48-86%, 35-91%, and 17-79%, respectively. ML potentially allows better prediction of the nodal status of PC, potentially allowing a better tailoring of pelvic irradiation.
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Affiliation(s)
- B De Bari
- 1Istituto del Radio "O. Alberti", Radiotherapy Department, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
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SBRT and extreme hypofractionation: A new era in prostate cancer treatments? Rep Pract Oncol Radiother 2014; 20:411-6. [PMID: 26696780 DOI: 10.1016/j.rpor.2014.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 07/30/2014] [Accepted: 09/30/2014] [Indexed: 01/31/2023] Open
Abstract
AIM Radiation therapy (RT) is a standard therapeutic option for prostate cancer (PC). In the last decades, several innovative technology applications have been introduced. 3-Dimensional conformal RT, volumetric/rotational intensity modulated RT associated or not with image-guided RT, are becoming largely diffused in the treatment of PC. BACKGROUND Considering that PC could have a low α/β ratio, similar to late-reacting normal tissues, it could also be highly responsive to fraction size. Thus, the reduction of the number of fractions and the increase of the dose/fraction seem to be reasonable choices in the treatment of this cancer. This review reported the technology evolution, the radiobiological and the clinical data about the role of extreme hypofractionated RT in the treatment approach of PC patients. MATERIALS AND METHODS Medline search and analysis of published studies containing key words: prostate cancer, radiotherapy, stereotactic radiotherapy. RESULTS Recent technological developments, combined with an improved knowledge of the radiobiological models in favor of a high sensitivity of PC to larger fraction sizes are opening a new scenario in its treatment, reporting favorable efficacy and acceptable toxicity, despite short follow-up. CONCLUSION Thus, thanks to technological improvement and the recent radiobiological data, "extreme hypofractionated RT" has been strongly introduced in the last years as a potential solid treatment option for PC.
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