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Janssen J, Staal F, Langendijk J, Both S, Brouwer C, Aluwini S. Pelvic lymph node motion during cone-beam computed tomography guided stereotactic radiotherapy. Clin Transl Radiat Oncol 2024; 47:100794. [PMID: 38798748 PMCID: PMC11127188 DOI: 10.1016/j.ctro.2024.100794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Background and purpose Stereotactic body radiotherapy (SBRT) is increasingly applied for pelvic lymph node recurrence. Thus far, knowledge on pelvic lymph node motion during CBCT-guided SBRT is lacking and the applied margins vary between institutions. This study evaluated pelvic lymph node motion during CBCT-guided SBRT and assessed the currently applied PTV margins of 3 and 5 mm. Material and methods In total, 45 pelvic lymph node metastases were included. One observer delineated 45 GTVs on planning CT, 224 GTVs on pre-fraction and 216 on post-fraction CBCT. The GTV centroid coordinates were derived from all images for inter- and intrafraction motion analysis. Additionally, we assessed the influence of treatment time and lesion location on lesion motion. The expected coverage of a 3-mm and 5-mm PTV margin was assessed using the inclusiveness index for GTVs on pre- and post-fraction CBCT. Results Lymph node interfraction motion was limited to 5 mm in 96-97 % of fractions for all translational directions and intrafraction lesion motion was limited to 3 mm in 97-100 % of fractions. Para-rectal lesions (11 %) were associated with significantly larger inter- and intrafraction motion compared to other pelvic locations and treatment duration showed no correlation with lesion motion. The mean (sd) lesion inclusiveness index was 99 % (5 %) for the 5-mm PTV margin and 96 % (9 %) for the 3-mm margin. Conclusion Pelvic lymph node motion during CBCT-guided stereotactic radiotherapy was within the widely applied PTV margin of 5 mm, providing an opportunity to reduce this margin for pelvic lymph node SBRT.
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Affiliation(s)
- J. Janssen
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - F.H.E. Staal
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J.A. Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S. Both
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C.L. Brouwer
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S. Aluwini
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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von Eyben R, Hoffmann MA, Soydal C, Virgolini I, Tuncel M, Gauthé M, Kapp DS, von Eyben FE. Pretest PSA and Restaging PSMA PET/CT Predict Survival in Biochemically Recurrent Prostate Cancer. Biomedicines 2023; 11:2333. [PMID: 37760775 PMCID: PMC10525266 DOI: 10.3390/biomedicines11092333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND A biochemical recurrence (BCR) risk model was created based on pretest prostate specific antigen (PSA) and groupings by restaging prostate specific membrane antigen (PSMA) PET/CT. METHODS A cohort of 1216 BCR patients were analyzed for overall survival (OS) according to the PSA threshold and restaging PSMA PET/CT. A Cox regression analysis of OS was carried out to detect significant clinical characteristics. RESULTS In the cohort, 271 patients had a pretest PSA of <0.5 ng/mL and 945 patients had higher PSA values. The restaging PSMA PET/CT was positive for 834 patients and negative for 369. Of 1203 patients, 133 (11%) died, including 19 of the 369 (5%) patients without positive sites on the restaging PSMA PET/CT, 82 of the 711 (12%) with 1-5 positive sites, and 32 of the 123 (26%) with >5 positive sites. In the Cox regression analysis, four variables significantly predicted OS: treatment center, International Society of Urologic Pathology (ISUP) grade, pretest PSA threshold, and the grouping of positive sites on the restaging PSMA PET/CT. CONCLUSIONS The pretest PSA and PSMA PET/CT were important for the OS of the BCR patients. The findings argue for the new BCR risk model and serve as framework for ongoing trials.
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Affiliation(s)
| | - Manuela Andrea Hoffmann
- Institute for Preventive Medicine of German Armed Forces, 56626 Andernach, Germany
- Department of Nuclear Medicine, University Medical Center, Johannes Gutenberg University in Mainz, 55131 Mainz, Germany
| | - Cigdem Soydal
- Department of Nuclear Medicine, University of Ankara, 0600 Ankara, Turkey;
| | - Irene Virgolini
- Department of Nuclear Medicine, University Hospital in Innsbruck, 6020 Innsbruck, Austria;
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, Ankara 06230, Turkey
| | - Mathieu Gauthé
- Department of Nuclear Medicine, Incept, Institute Holland, 38100 Grenoble, France;
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Janssen J, Brouwer CL, Staal FH, van Herpt HE, Both S, Langendijk JA, Aluwini S. Simple immobilization for stereotactic radiotherapy aimed at pelvic metastases. Phys Imaging Radiat Oncol 2023; 27:100460. [PMID: 37435559 PMCID: PMC10331836 DOI: 10.1016/j.phro.2023.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) is increasingly applied for pelvic oligometastases of prostate cancer, and currently no simple immobilization method is available for cone beam computed tomography (CBCT)-guided treatment. We assessed patient set-up and intrafraction motion using simple immobilization during CBCT-guided pelvic SBRT. Forty patients were immobilized with basic arm- head- and knee support and either a thermoplastic cushion or a foam cushion. Analysis of 454 CBCTs showed mean intrafraction translation <3.0 mm in 94% of fractions and mean intrafraction rotation <1.5° in 95% of fractions. Therefore, simple immobilization ensured stable patient positioning during CBCT-guided pelvic SBRT.
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Affiliation(s)
- Jorinde Janssen
- Corresponding author at: University Medical Center Groningen, Department of Radiation Oncology, Hanzeplein 1, 9713GZ Groningen, the Netherlands.
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ESTRO-ACROP recommendations for evidence-based use of androgen deprivation therapy in combination with external-beam radiotherapy in prostate cancer. Radiother Oncol 2023; 183:109544. [PMID: 36813168 DOI: 10.1016/j.radonc.2023.109544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND PURPOSE There is no consensus concerning the appropriate use of androgen deprivation therapy (ADT) during primary and postoperative external-beam radiotherapy (EBRT) in the management of prostate cancer (PCa). Thus, the European Society for Radiotherapy and Oncology (ESTRO) Advisory Committee for Radiation Oncology Practice (ACROP) guidelines seeks to present current recommendations for the clinical use of ADT in the various indications of EBRT. MATERIAL AND METHODS A literature search was conducted in MEDLINE PubMed that evaluated EBRT and ADT in prostate cancer. The search focused on randomized, Phase II and III trials published in English from January 2000 to May 2022. In case topics were addressed in the absence of Phase II or III trials, recommendations were labelled accordingly based on the limited body of evidence. Localized PCa was classified according to D'Amico et al. classification in low-, intermediate and high risk PCa. The ACROP clinical committee identified 13 European experts who discussed and analyzed the body of evidence concerning the use of ADT with EBRT for prostate cancer. RESULTS Key issues were identified and are discussed: It was concluded that no additional ADT is recommended for low-risk prostate cancer patients, whereas for intermediate- and high-risk patients four to six months and two to three years of ADT are recommended. Likewise, patients with locally advanced prostate cancer are recommended to receive ADT for two to three years and when ≥ 2 high-risk factors (cT3-4, ISUP grade ≥ 4 or PSA ≥ 40 ng/ml) or cN1 is present ADT for three years plus additional Abiraterone for two years is recommended. For postoperative patients no ADT is recommended for adjuvant EBRT in pN0 patients whereas for pN1 patients adjuvant EBRT with long-term ADT is performed for at least 24 to 36 months. In the setting of salvage EBRT ADT is performed in biochemically persistent PCa patients with no evidence of metastatic disease. Long-term ADT (24 months) is recommended in pN0 patients with high risk of further progression (PSA ≥ 0.7 ng/ml and ISUP grade group ≥ 4) and a life expectancy of over ten years, whereas short-term ADT (6 months) is recommended in pN0 patients with lower risk profile (PSA < 0.7 ng/ml and ISUP grade group 4). Patients considered for ultra-hypofractionated EBRT as well as patients with image based local recurrence within the prostatic fossa or lymph node recurrence should participate in appropriate clinical trials evaluating the role of additional ADT. CONCLUSION These ESTRO-ACROP recommendations are evidence-based and relevant to the use of ADT in combination with EBRT in PCa for the most common clinical settings.
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Gravestock P, Somani BK, Tokas T, Rai BP. A Review of Modern Imaging Landscape for Prostate Cancer: A Comprehensive Clinical Guide. J Clin Med 2023; 12:jcm12031186. [PMID: 36769834 PMCID: PMC9918161 DOI: 10.3390/jcm12031186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
The development of prostate cancer imaging is rapidly evolving, with many changes to the way patients are diagnosed, staged, and monitored for recurrence following treatment. New developments, including the potential role of imaging in screening and the combined diagnostic and therapeutic applications in the field of theranostics, are underway. In this paper, we aim to outline the current landscape in prostate cancer imaging and look to the future at the potential modalities and applications to come.
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Affiliation(s)
- Paul Gravestock
- Department of Urology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, 6060 Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria
| | - Bhavan Prasad Rai
- Department of Urology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
- Correspondence:
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de Barros HA, van Beurden I, Droghetti M, Wilthagen EA, Özman O, Bergman AM, Aluwini S, van Moorselaar RJA, Donswijk ML, van Leeuwen PJ, van der Poel HG. Role of Local and/or Metastasis-directed Therapy in Patients with Hormone-sensitive M1a Prostate Cancer-A Systematic Review. Eur Urol Oncol 2023; 6:16-27. [PMID: 36372736 DOI: 10.1016/j.euo.2022.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/20/2022] [Accepted: 10/09/2022] [Indexed: 11/11/2022]
Abstract
CONTEXT It remains unclear whether men with hormone-sensitive prostate cancer (PCa) metastasized to nonregional lymph nodes (M1a) benefit from prostate-directed therapy (PDT) and/or metastasis-directed therapy (MDT). OBJECTIVE To systematically summarize the literature regarding oncological outcomes of de novo and recurrent M1a PCa patients treated with PDT and/or MDT. EVIDENCE ACQUISITION We searched Medline (Ovid), Embase, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for reports on oncological outcomes of de novo or recurrent hormone-sensitive M1a PCa patients treated with PDT (radical prostatectomy or radiotherapy) and/or MDT (nodal radiotherapy or salvage lymph node dissection) with or without androgen deprivation therapy. A descriptive data synthesis and a methodological quality assessment were performed to evaluate the impact of PDT and/or MDT on survival in M1a PCa patients. EVIDENCE SYNTHESIS A total of 6136 articles were screened and 24 studies were included in this systematic review. In de novo M1a PCa patients, PDT was associated with improved oncological outcomes compared with no PDT. In recurrent M1a PCa, MDT could delay the need for systemic treatment in a selection of patients, but high-level evidence from prospective phase III randomized controlled trials is still awaited. CONCLUSIONS This systematic review summarized the limited literature data on the management of M1a PCa. Subgroup analyses suggest a role for PDT plus systemic therapy in de novo M1a PCa. MDT to distant nodal metastases delayed the need for systemic therapy in recurrent disease, but robust data are lacking. The predominantly retrospective nature of the included studies and significant heterogeneity in study designs limit the strength of evidence. PATIENT SUMMARY We reviewed the treatment of patients with prostate cancer that has spread to lymph nodes outside the pelvis without metastases in other organ systems. There is evidence that treatment of the primary prostate tumor improves outcomes in well-selected patients and that treatment targeting distant lymph node metastases can delay the start of systemic treatment.
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Affiliation(s)
- Hilda A de Barros
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands.
| | - Isabeau van Beurden
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands
| | - Matteo Droghetti
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Erica A Wilthagen
- Scientific Information Service, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Oktay Özman
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands
| | - Andries M Bergman
- Department of Medical Oncology and Oncogenomics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Shafak Aluwini
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - R Jeroen A van Moorselaar
- Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
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7
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von Eyben R, Kapp DS, Hoffmann MA, Soydal C, Uprimny C, Virgolini I, Tuncel M, Gauthé M, von Eyben FE. A Risk Model for Patients with PSA-Only Recurrence (Biochemical Recurrence) Based on PSA and PSMA PET/CT: An Individual Patient Data Meta-Analysis. Cancers (Basel) 2022; 14:cancers14215461. [PMID: 36358880 PMCID: PMC9657957 DOI: 10.3390/cancers14215461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
An individual patient meta-analysis followed 1216 patients with PSA-only recurrence (biochemical recurrence, BCR) restaged with [68Ga]Ga-PSMA-11 PET/CT before the salvage treatment for median 3.5 years and analyzed the overall survival (OS). A new risk model included a good risk group with a prescan PSA < 0.5 ng/mL (26%), an intermediate risk group with a prescan PSA > 0.5 ng/mL and a PSMA PET/CT with 1 to 5 positive sites (65%), and a poor risk group with a prescan PSA > 0.5 ng/mL and a PSA PET/CT with > 5 positive sites (9%) (p < 0.0001, log rank test). The poor risk group had a five-year OS > 60%. Adding a BCR risk score by the European Association of Urology did not significantly improve the prediction of OS (p = 0.64). In conclusion, the restaging PSMA PET/CT markedly predicted the 5-year OS. The new risk model for patients with PSA-only relapse requires a restaging PSMA PET/CT for patients with a prescan PSA > 0.5 ng/mL and has a potential use in new trials aiming to improve the outcome for patients with PSA-only recurrence who have polysites prostate cancer detected on PSMA PET/CT.
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Affiliation(s)
- Rie von Eyben
- Cytel Incorporated, 1050 Winter St, Waltam, MA 02452, USA;
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA 94305, USA;
| | - Manuela Andrea Hoffmann
- Department of Occupational Health & Safety, Federal Ministry of Defense, 53123 Bonn, Germany;
- Department of Nuclear Medicine, University Medical Center, Johannes Gutenberg University in Mainz, 55101 Mainz, Germany
| | - Cigdem Soydal
- Department of Nuclear Medicine, University of Ankara, Ankara 06100, Turkey;
| | - Christian Uprimny
- Department of Nuclear Medicine, University Hospital in Innsbruck, 6020 Innsbruck, Austria; (C.U.); (I.V.)
| | - Irene Virgolini
- Department of Nuclear Medicine, University Hospital in Innsbruck, 6020 Innsbruck, Austria; (C.U.); (I.V.)
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, Ankara 06230, Turkey;
| | - Mathieu Gauthé
- Department of Nuclear Medicine, Incept, Institute Holland, 38100 Grenoble, France;
| | - Finn E. von Eyben
- Center of Tobacco Control Research, 5320 Odense, Denmark
- Correspondence:
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Zilli T, Achard V, Dal Pra A, Schmidt-Hegemann N, Jereczek-Fossa BA, Lancia A, Ingrosso G, Alongi F, Aluwini S, Arcangeli S, Blanchard P, Conde Moreno A, Couñago F, Créhange G, Dirix P, Gomez Iturriaga A, Guckenberger M, Pasquier D, Sargos P, Scorsetti M, Supiot S, Tree AC, Zapatero A, Le Guevelou J, Ost P, Belka C. Recommendations for radiation therapy in oligometastatic prostate cancer: An ESTRO-ACROP Delphi consensus. Radiother Oncol 2022; 176:199-207. [PMID: 36228761 DOI: 10.1016/j.radonc.2022.10.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Oligometastatic prostate cancer is a new and emerging treatment field with only few prospective randomized studies published so far. Despite the lack of strong level I evidence, metastasis-directed therapies (MDT) are widely used in clinical practice, mainly based on retrospective and small phase 2 studies and with a large difference across centers. Pending results of ongoing prospective randomized trials, there is a clear need for more consistent treatment indications and radiotherapy practices. MATERIAL AND METHODS A European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee consisting of radiation oncologists' experts in prostate cancer was asked to answer a dedicated questionnaire, including 41 questions on the main controversial issues with regard to oligometastatic prostate cancer. RESULTS The panel achieved consensus on patient selection and routine use of prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging as preferred staging and restaging imaging. MDT strategies are recommended in the de novo oligometastatic, oligorecurrent and oligoprogressive disease setting for nodal, bone and visceral metastases. Radiation therapy doses, volumes and techniques were discussed and commented. CONCLUSION These recommendations have the purpose of providing standardization and consensus to optimize the radiotherapy treatment of oligometastatic prostate cancer until mature results of randomized trials are available.
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Affiliation(s)
- Thomas Zilli
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland.
| | - Vérane Achard
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Andrea Lancia
- Department of Radiation Oncology, Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy
| | - Gianluca Ingrosso
- Department of Radiation Oncology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar di Valpolicella, Italy; University of Brescia, Brescia, Italy
| | - Shafak Aluwini
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Pierre Blanchard
- Université Paris Saclay, Villejuif, France; Inserm U1018 Oncostat, Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Antonio Conde Moreno
- Radiation Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, CEU Cardenal Herrera University, Castellón, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Department of Radiation Oncology, Hospital La Luz, Madrid, Spain; Medicine Department, School of Biomedical Sciences, Universidad Europea, Villaviciosa de Odón, Madrid, Spain
| | - Gilles Créhange
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Piet Dirix
- Department of Radiation-Oncology, Iridium Network, Antwerp, Belgium
| | - Alfonso Gomez Iturriaga
- Biocruces Health Research Institute, Cruces University Hospital, Basque Country University (UPV/EHU), Barakaldo, Bizkaia, Spain
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; CRIStAL UMR CNRS 9189, Lille University, Lille, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest René Gauducheau, Saint-Herblain, France
| | - Alison C Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Almudena Zapatero
- Department of Radiation Oncology, Health Research Institute, University Hospital La Princesa, Madrid, Spain
| | - Jennifer Le Guevelou
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Piet Ost
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Department of Radiation Oncology, Iridium Network, GZA ziekenhuizen, Wilrijk, Belgium
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
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9
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Tamihardja J, Zehner L, Hartrampf P, Lisowski D, Kneitz S, Cirsi S, Razinskas G, Flentje M, Polat B. Salvage Nodal Radiotherapy as Metastasis-Directed Therapy for Oligorecurrent Prostate Cancer Detected by Positron Emission Tomography Shows Favorable Outcome in Long-Term Follow-Up. Cancers (Basel) 2022; 14:cancers14153766. [PMID: 35954430 PMCID: PMC9367596 DOI: 10.3390/cancers14153766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Patients, who suffer from oligorecurrent prostate cancer with limited nodal involvement, may be offered positron emission tomography (PET)-directed salvage nodal radiotherapy to delay disease progression. This current analysis aimed to access salvage radiotherapy for nodal oligorecurrent prostate cancer with simultaneous integrated boost to PET-involved lymph nodes as metastasis-directed therapy. A long-term oncological outcome was favorable after salvage nodal radiotherapy and severe toxicity rates were low. Androgen deprivation therapy plays a major role in recurrent prostate cancer management and demonstrates a positive influence on the rate of biochemical progression in patients receiving salvage nodal radiotherapy. The present long-term analysis may help clinicians identify patients who would benefit from salvage nodal radiotherapy and androgen deprivation therapy, as a multimodal treatment strategy for oligorecurrent prostate cancer. Abstract Background: The study aimed to access the long-term outcome of salvage nodal radiotherapy (SNRT) in oligorecurrent prostate cancer. Methods: A total of 95 consecutive patients received SNRT for pelvic and/or extrapelvic nodal recurrence after prostate-specific membrane antigen (PSMA) or choline PET from 2010 to 2021. SNRT was applied as external beam radiotherapy with simultaneous integrated boost up to a median total dose of 62.9 Gy (EQD21.5Gy) to the recurrent lymph node metastases. The outcome was analyzed by cumulative incidence functions with death as the competing risk. Fine–Gray regression analyses were performed to estimate the relative hazards of the outcome parameters. Genitourinary (GU)/gastrointestinal (GI) toxicity evaluation utilized Common Toxicity Criteria for Adverse Events (v5.0). The results are as follows: the median follow-up was 47.1 months. The five-year biochemical progression rate (95% CI) was 50.1% (35.7–62.9%). Concomitant androgen deprivation therapy (ADT) was adminstered in 60.0% of the patients. The five-year biochemical progression rate was 75.0% (42.0–90.9%) without ADT versus 35.3% (19.6–51.4%) with ADT (p = 0.003). The cumulative five-year late grade 3 GU toxicity rate was 2.1%. No late grade 3 GI toxicity occured. Conclusions: Metastasis-directed therapy through SNRT for PET-staged oligorecurrent prostate cancer demonstrated a favorable long-term oncologic outcome. Omittance of ADT led to an increased biochemical progression.
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Affiliation(s)
- Jörg Tamihardja
- Department of Radiation Oncology, University of Wuerzburg, 97080 Wuerzburg, Germany; (L.Z.); (D.L.); (S.C.); (G.R.); (M.F.); (B.P.)
- Correspondence:
| | - Leonie Zehner
- Department of Radiation Oncology, University of Wuerzburg, 97080 Wuerzburg, Germany; (L.Z.); (D.L.); (S.C.); (G.R.); (M.F.); (B.P.)
| | - Philipp Hartrampf
- Department of Nuclear Medicine, University of Wuerzburg, 97080 Wuerzburg, Germany;
| | - Dominik Lisowski
- Department of Radiation Oncology, University of Wuerzburg, 97080 Wuerzburg, Germany; (L.Z.); (D.L.); (S.C.); (G.R.); (M.F.); (B.P.)
| | - Susanne Kneitz
- Biochemistry and Cell Biology, Biocenter, University of Wuerzburg, 97074 Wuerzburg, Germany;
| | - Sinan Cirsi
- Department of Radiation Oncology, University of Wuerzburg, 97080 Wuerzburg, Germany; (L.Z.); (D.L.); (S.C.); (G.R.); (M.F.); (B.P.)
| | - Gary Razinskas
- Department of Radiation Oncology, University of Wuerzburg, 97080 Wuerzburg, Germany; (L.Z.); (D.L.); (S.C.); (G.R.); (M.F.); (B.P.)
| | - Michael Flentje
- Department of Radiation Oncology, University of Wuerzburg, 97080 Wuerzburg, Germany; (L.Z.); (D.L.); (S.C.); (G.R.); (M.F.); (B.P.)
| | - Bülent Polat
- Department of Radiation Oncology, University of Wuerzburg, 97080 Wuerzburg, Germany; (L.Z.); (D.L.); (S.C.); (G.R.); (M.F.); (B.P.)
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