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Mohan R, Kneebone A, Eade T, Hsiao E, Emmett L, Brown C, Hunter J, Hruby G. Long-term outcomes of SBRT for PSMA PET detected oligometastatic prostate cancer. Radiat Oncol 2023; 18:127. [PMID: 37528487 PMCID: PMC10394924 DOI: 10.1186/s13014-023-02302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Oligometastatic disease in prostate cancer (PCa) is a challenging clinical scenario encountered more frequently with the widespread adoption of PSMA-PET. SBRT aims to defer androgen deprivation and may deliver sustained biochemical failure (BF) free survival in selected patients. Little long-term data is currently available regarding the effectiveness of this approach. METHODS A retrospective single institution study of PSMA-PET directed SBRT without initial ADT for oligo-metachronous PCa. Median dose/fractionation was 24 Gy in 2# to bones and 30 Gy in 3# to lymph nodes. The primary endpoint was time to BF (PSA + 0.2 ug/L above nadir). Secondary endpoints included time to ADT for relapse (i.e. palliative ADT), BF defined as PSA nadir + 2 ug/L, toxicity, patterns of failure and survival. Patients were excluded if they received ADT with their SBRT, had short disease-free interval, or > 3 metastases on PSMA-PET. RESULTS 103 patients treated from November-2014 to December-2019 were analysed from our prospective database. Median follow-up was 5 years. 64 patients were treated for nodal only disease, 35 bone only and 4 mixed. 15% were free of any BF at 5 years with median time to BF of 1.1 years. 32% (33/103) of patients had further curative-intent radiation treatment following their first BF after SBRT, including subsequent SBRT. Eight patients underwent potentially curative treatment for their second or third relapse. Allowing for salvage treatment, 29/103 (28%) were biochemically disease free at last follow up. At 5 years, 39% of patients had never received any ADT and 55% had not started ADT for relapse with a median time to ADT for relapse of 5.5 years. There were 2 grade 3 toxicities (rib fracture and lymphoedema), and no local failures. CONCLUSION PSMA-PET guided SBRT for oligo-metachronous PCa recurrence in appropriately triaged patients results in excellent local control, low toxicity and over 50% ADT free at 5 years.
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Affiliation(s)
- Riche Mohan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia.
| | - A Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - T Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - E Hsiao
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - L Emmett
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
- Garvan Institute of Medical Research, Darlinghurst, 2010, Australia
| | - Christopher Brown
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - J Hunter
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - G Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
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Back M, Jayamanne D, Brazier D, Newey A, Bailey D, Schembri G, Hsiao E, Khasraw M, Wong M, Kastelan M, Brown C, Wheeler H. Pattern of failure in anaplastic glioma patients with an IDH1/2 mutation. Strahlenther Onkol 2019; 196:31-39. [PMID: 31028406 DOI: 10.1007/s00066-019-01467-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/29/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The current study aimed to assess patterns of failure (PoF) in anaplastic glioma (AG) patients managed with intensity-modulated radiation therapy (IMRT) and their relationship to molecular subtype. METHODS The outcomes of AG patients managed between 2008 and 2014 and entered into a prospective database were assessed, including PoF. AG was initially defined using the WHO 2007 classification, but for analysis, patients were subsequently recategorised based on WHO 2016 as anaplastic oligodendroglioma (AOD), astrocytoma isocitrate dehydrogenase (IDH) mutant (AAmut) or astrocytoma IDH wildtype (AAwt). Management involved IMRT and temozolomide (TMZ), including from 2011 patients with an IDH mutation (IDHmut) planned with 18F-fluoroethyltyrosine (FET) and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET). PoF was local, marginal or distant in relation to the IMRT volume. Relapse-free survival (RFS) was calculated from the start of IMRT. RESULTS A total of 156 patients were assessed, with median follow-up of 5.1 years. Of these patients, 75% were IDHmut, 44% were managed at first or later relapse and 73% received TMZ. Relapse occurred in 68 patients, with 6‑year RFS of 75.0, 48.8 and 2.5% for AOD, AAmut and AAwt, respectively (p < 0.001). There was a component of local relapse in 63%, of marginal relapse in 19% and of distant relapse in 37% of relapses. Isolated local, marginal and distant relapse was evident in 51, 9 and 22%, respectively. A distant relapse pattern was more frequent in IDHmut compared to IDHwt patients (26% vs. 45%, p = 0.005), especially within the first 2 years post-IMRT. In multivariate analysis, distant relapse remained associated with AAmut (p < 0.002) and delayed IMRT until the second relapse (p < 0.001). CONCLUSION Although patients with IDH-mutated AG have improved outcomes, there was a higher proportion of distant relapses occurring during the 2 years after IMRT.
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Affiliation(s)
- M Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney NSW 2065, Sydney, Australia.
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia.
- Genesis Cancer Care, Sydney, Australia.
- Sydney Medical School, University of Sydney, Sydney, Australia.
- The Brain Cancer Group, Sydney, Australia.
| | - D Jayamanne
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney NSW 2065, Sydney, Australia
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| | - D Brazier
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney NSW 2065, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - A Newey
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney NSW 2065, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - D Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - G Schembri
- The Brain Cancer Group, Sydney, Australia
| | - E Hsiao
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - M Khasraw
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney NSW 2065, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- The Brain Cancer Group, Sydney, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - M Wong
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| | - M Kastelan
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney NSW 2065, Sydney, Australia
- The Brain Cancer Group, Sydney, Australia
| | - C Brown
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney NSW 2065, Sydney, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - H Wheeler
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards Sydney NSW 2065, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- The Brain Cancer Group, Sydney, Australia
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Dilday B, Howell DA, Cenko SB, Silverman JM, Nugent PE, Sullivan M, Ben-Ami S, Bildsten L, Bolte M, Endl M, Filippenko AV, Gnat O, Horesh A, Hsiao E, Kasliwal MM, Kirkman D, Maguire K, Marcy GW, Moore K, Pan Y, Parrent JT, Podsiadlowski P, Quimby RM, Sternberg A, Suzuki N, Tytler DR, Xu D, Bloom JS, Gal-Yam A, Hook IM, Kulkarni SR, Law NM, Ofek EO, Polishook D, Poznanski D. PTF 11kx: A Type Ia Supernova with a Symbiotic Nova Progenitor. Science 2012; 337:942-5. [PMID: 22923575 DOI: 10.1126/science.1219164] [Citation(s) in RCA: 265] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- B. Dilday
- Las Cumbres Observatory Global Telescope Network, 6740 Cortona Drive, Suite 102, Goleta, CA 93117, USA
- Department of Physics, University of California, Santa Barbara, Broida Hall, Mail Code 9530, Santa Barbara, CA 93106–9530, USA
| | - D. A. Howell
- Las Cumbres Observatory Global Telescope Network, 6740 Cortona Drive, Suite 102, Goleta, CA 93117, USA
- Department of Physics, University of California, Santa Barbara, Broida Hall, Mail Code 9530, Santa Barbara, CA 93106–9530, USA
| | - S. B. Cenko
- Department of Astronomy, University of California, Berkeley, CA 94720–3411, USA
| | - J. M. Silverman
- Department of Astronomy, University of California, Berkeley, CA 94720–3411, USA
| | - P. E. Nugent
- Department of Astronomy, University of California, Berkeley, CA 94720–3411, USA
- Lawrence Berkeley National Laboratory, Mail Stop 50B-4206, 1 Cyclotron Road, Berkeley, CA 94720, USA
| | - M. Sullivan
- Department of Physics (Astrophysics), University of Oxford, Keble Road, Oxford OX1 3RH, UK
| | - S. Ben-Ami
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - L. Bildsten
- Department of Physics, University of California, Santa Barbara, Broida Hall, Mail Code 9530, Santa Barbara, CA 93106–9530, USA
- Kavli Institute for Theoretical Physics, University of California, Santa Barbara, CA 93106, USA
| | - M. Bolte
- University of California Observatories, Lick Observatory, University of California, Santa Cruz, CA 95064, USA
| | - M. Endl
- McDonald Observatory, University of Texas at Austin, Austin, TX 78712, USA
| | - A. V. Filippenko
- Department of Astronomy, University of California, Berkeley, CA 94720–3411, USA
| | - O. Gnat
- Racah Institute of Physics, Hebrew University of Jerusalem, 91904, Israel
| | - A. Horesh
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - E. Hsiao
- Lawrence Berkeley National Laboratory, Mail Stop 50B-4206, 1 Cyclotron Road, Berkeley, CA 94720, USA
- Carnegie Institution of Washington, Las Campanas Observatory, Colina El Pino, Casilla 601, Chile
| | - M. M. Kasliwal
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
- Observatories of the Carnegie Institution for Science, 813 Santa Barbara Street, Pasadena, CA 91101, USA
| | - D. Kirkman
- Center for Astrophysics and Space Sciences, University of California San Diego, La Jolla, CA 92093–0424, USA
| | - K. Maguire
- Department of Physics (Astrophysics), University of Oxford, Keble Road, Oxford OX1 3RH, UK
| | - G. W. Marcy
- Department of Astronomy, University of California, Berkeley, CA 94720–3411, USA
| | - K. Moore
- Department of Physics, University of California, Santa Barbara, Broida Hall, Mail Code 9530, Santa Barbara, CA 93106–9530, USA
| | - Y. Pan
- Department of Physics (Astrophysics), University of Oxford, Keble Road, Oxford OX1 3RH, UK
| | - J. T. Parrent
- Las Cumbres Observatory Global Telescope Network, 6740 Cortona Drive, Suite 102, Goleta, CA 93117, USA
- Department of Physics and Astronomy, Dartmouth College, Hanover, NH, USA
| | - P. Podsiadlowski
- Department of Physics (Astrophysics), University of Oxford, Keble Road, Oxford OX1 3RH, UK
| | - R. M. Quimby
- Institute for the Physics and Mathematics of the Universe, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa-shi, Chiba 277-8583, Japan
| | - A. Sternberg
- Minerva Fellow, Max Planck Institute for Astrophysics, Karl Schwarzschild Strasse 1, D-85741 Garching, Germany
| | - N. Suzuki
- Lawrence Berkeley National Laboratory, Mail Stop 50B-4206, 1 Cyclotron Road, Berkeley, CA 94720, USA
| | - D. R. Tytler
- Center for Astrophysics and Space Sciences, University of California San Diego, La Jolla, CA 92093–0424, USA
| | - D. Xu
- Department of Particle Physics and Astrophysics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - J. S. Bloom
- Department of Astronomy, University of California, Berkeley, CA 94720–3411, USA
| | - A. Gal-Yam
- Benoziyo Center for Astrophysics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - I. M. Hook
- Department of Physics (Astrophysics), University of Oxford, Keble Road, Oxford OX1 3RH, UK
| | - S. R. Kulkarni
- Cahill Center for Astrophysics, California Institute of Technology, Pasadena, CA 91125, USA
| | - N. M. Law
- University of Toronto, 50 St. George Street, Toronto M5S 3H4, Ontario, Canada
| | - E. O. Ofek
- Benoziyo Center for Astrophysics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - D. Polishook
- Department of Earth, Atmospheric, and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - D. Poznanski
- School of Physics and Astronomy, Tel-Aviv University, Tel-Aviv 69978, Israel
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