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Wang Y, Chen R, Deng X, Jiang X. Incidence and associated factors of developing second pelvic malignant neoplasms among prostate cancer patients treated with radiotherapy. Front Oncol 2023; 13:1260325. [PMID: 38044985 PMCID: PMC10693410 DOI: 10.3389/fonc.2023.1260325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023] Open
Abstract
Objective To identify risk factors of secondary pelvic malignant neoplasms (SPMNs) among prostate cancer (PCa) patients treated with radiotherapy. Simultaneously, population-based data were used to validate the high risk of SPMNs in PCa patients with radiotherapy. Materials and methods We identified male patients diagnosed with PCa (localized and regional) as the first primary cancer and pelvic malignant neoplasm (including bladder and rectal cancer) as secondary cancer from Surveillance, Epidemiology, and End Results database (1975-2020). An external validation cohort was obtained from the First Affiliated Hospital of Nanchang University. The Fine-Gray competing risk regression and Poisson regression were utilized to evaluate the risk of SPMNs development. Poisson regression was also performed to calculate the standardized incidence ratio (SIR). The Kaplan-Meier method was used to assess the overall survival (OS) of patients with SPMNs. Results 89397 PCa patients treated with radiotherapy were enrolled. We identified associated factors of SPMNs, including age at diagnosis, race, year of diagnosis, marital status, radiation strategy and latency. In the multivariable competing risk regression model and Poisson regression model, a significantly higher risk of SPMNs development was observed in patients over 50 years(P<0.05), white patients(P<0.001), unmarried patients and treated with brachytherapy combined with external beam radiotherapy or brachytherapy(P<0.05). Patients treated with radiotherapy had a higher bladder and rectal cancer incidence than the general population. Patients who developed SPMNs showed poorer OS. Conclusion We identified several risk factors associated with SPMNs and confirmed a relatively higher incidence of bladder and rectal cancer among PCa patients with radiotherapy. These results help tailor treatment and surveillance strategies.
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Affiliation(s)
- Youbiao Wang
- Department of Urology, The Second People’s Hospital of Jingdezhen City, Jingdezhen, Jiangxi, China
| | - Ru Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xinxi Deng
- Department of Urology, Jiujiang First People’s Hospital, Jiujiang, Jiangxi, China
| | - Xinghua Jiang
- Department of Urology, The Second People’s Hospital of Jingdezhen City, Jingdezhen, Jiangxi, China
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Kubeš J, Sláviková S, Vítek P, Haas A, Ondrová B, Dedečková K, Andrlík M, Domanský M, Jiránková K, Schlencová V, Harazimová A, Turková B, Doležal T, Al-Hamami SFA, Vondráček V. 5-Years Analysis of Effectivity and Toxicity of Ultra-Hypofractionated Proton Radiotherapy in the Treatment of Low- and Intermediate-Risk Prostate Cancer-A Retrospective Analysis. Cancers (Basel) 2023; 15:4571. [PMID: 37760540 PMCID: PMC10526468 DOI: 10.3390/cancers15184571] [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: 07/28/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND We retrospectively analyzed the 5-year biochemical disease-free survival (bDFS) and occurrence of late toxicity in prostate cancer patients treated with pencil beam scanning (PBS) proton radiotherapy. METHODOLOGY In the period from January 2013 to June 2018, 853 patients with prostate cancer were treated with an ultra-hypofractionated schedule (36.25 GyE/five fractions). The mean PSA value was 6.7 (0.7-19.7) µg/L. There were 318 (37.3%), 314 (36.8%), and 221 (25.9%) patients at low (LR), favorable intermediate (F-IR), and unfavorable intermediate risk (U-IR), respectively. Neoadjuvant hormonal therapy was administered to 197 (23.1%) patients, and 7 (0.8%) patients had adjuvant hormonal therapy. The whole group of patients reached median follow-up time at 62.7 months, and their mean age was 64.8 (40.0-85.7) years. The bDFS rates and late toxicity profile were evaluated. RESULTS Median treatment time was 10 (7-38) days. Estimated 5-year bDFS rates were 96.5%, 93.7%, and 91.2% for low-, favorable intermediate-, and unfavorable intermediate-risk groups, respectively. Cumulative late toxicity (CTCAE v4.0) of G2+ was as follows: gastrointestinal (GI)-G2: 9.1%; G3: 0.5%; genitourinary (GU)-G2: 4.3%, and no G3 toxicity was observed. PSA relapse was observed in 58 (6.8%) patients: 16 local, 22 lymph node, 4 bone recurrences, and 10 combined sites of relapse were detected. Throughout the follow-up period, 40 patients (4.7%) died, though none due to prostate cancer. CONCLUSION Ultra-hypofractionated proton beam radiotherapy is an effective treatment for low- and favorable intermediate-risk prostate cancer, with long-term bDFS rates comparable to other techniques. It is promising for unfavorable intermediate-risk prostate cancer and has acceptable long-term GI and favorable GU toxicity.
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Affiliation(s)
- Jiri Kubeš
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
- Department of Health Care Disciplines and Population Protection, Faculty of Biomedical Engineering, Czech Technical University Prague, Sítná Square 3105, 272 01 Kladno, Czech Republic
| | - Silvia Sláviková
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Pavel Vítek
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
- Department of Oncology, 1st Faculty of Medicine and General University Hospital, Charles University, Kateřinská 32, 121 08 Praha, Czech Republic
| | - Alexandra Haas
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Barbora Ondrová
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Kateřina Dedečková
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Michal Andrlík
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Martin Domanský
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Kateřina Jiránková
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Veronika Schlencová
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Anh Harazimová
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Barbora Turková
- Value Outcomes Ltd., Václavská 316/12, 120 00 Praha, Czech Republic; (B.T.); (T.D.)
| | - Tomáš Doležal
- Value Outcomes Ltd., Václavská 316/12, 120 00 Praha, Czech Republic; (B.T.); (T.D.)
| | - Sarah Falah Abass Al-Hamami
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
| | - Vladimír Vondráček
- Proton Therapy Center Czech, Budínova 1a, 180 00 Prague, Czech Republic; (J.K.); (S.S.); (P.V.); (A.H.); (B.O.); (K.D.); (M.D.); (K.J.); (V.S.); (A.H.); (S.F.A.A.-H.); (V.V.)
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Lo Greco MC, Marletta G, Marano G, Fazio A, Buffettino E, Iudica A, Liardo RLE, Milazzotto R, Foti PV, Palmucci S, Basile A, Marletta F, Cuccia F, Ferrera G, Parisi S, Pontoriero A, Pergolizzi S, Spatola C. Hypofractionated Radiotherapy in Localized, Low-Intermediate-Risk Prostate Cancer: Current and Future Prospectives. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1144. [PMID: 37374348 DOI: 10.3390/medicina59061144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
At the time of diagnosis, the vast majority of prostate carcinoma patients have a clinically localized form of the disease, with most of them presenting with low- or intermediate-risk prostate cancer. In this setting, various curative-intent alternatives are available, including surgery, external beam radiotherapy and brachytherapy. Randomized clinical trials have demonstrated that moderate hypofractionated radiotherapy can be considered as a valid alternative strategy for localized prostate cancer. High-dose-rate brachytherapy can be administered according to different schedules. Proton beam radiotherapy represents a promising strategy, but further studies are needed to make it more affordable and accessible. At the moment, new technologies such as MRI-guided radiotherapy remain in early stages, but their potential abilities are very promising.
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Affiliation(s)
- Maria Chiara Lo Greco
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giulia Marletta
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giorgia Marano
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Alessandro Fazio
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Emanuele Buffettino
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Arianna Iudica
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Rocco Luca Emanuele Liardo
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Roberto Milazzotto
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Pietro Valerio Foti
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Antonio Basile
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | | | | | | | - Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Corrado Spatola
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
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