2
|
Chan E, Pugh SL, Simko J, Feng FY, Shipley WU, Lukka H, Bahary JP, Pisansky TM, Zeitzer KL, Lawton CA, Efstathiou JA, Rosenthal SA, Balogh AG, Lovett RD, Wong AC, Dess RT, McGinnis S, Kuettel MR, Demora L, Sandler HM. Impact of lymph node yield at prostatectomy on outcomes in NRG/RTOG 9601. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.265] [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] [Indexed: 11/20/2022] Open
Abstract
265 Background: A recent study ( Fossati et al, 2018) found that higher lymph node count at radical prostatectomy was associated with improved outcomes in patients treated with salvage radiation for elevated prostate-specific antigen (PSA) after surgery. We sought to validate these results in NRG/RTOG 9601, a randomized controlled trial of men with pT2/T3 disease who underwent either radiation (RT) alone or RT+antiandrogen (bicalutamide) therapy for PSA elevation following radical prostatectomy from 1998-2003. Methods: We reviewed available pathology reports for all patients in NRG/RTOG 9601 to determine the nodal count at radical prostatectomy. Clinical data was as of 11/5/2015, same as the primary endpoint for the trial. Cox proportional hazards models were used to assess the effect of number of positive lymph nodes, treatment arm (RT alone or RT+bicalutamide), Gleason score, positive margins, and seminal vesicle invasion on the following endpoints: times to local and distant failure and overall and disease specific survival. Results: Out of the 760 patients originally eligible in the trial, 552 (73%, 276 in each arm) had complete data available. Median node count in the entire cohort was 6 (range 0-33, Q1-Q3 3-9). There were no significant differences between treatment arms in terms of patient demographic or clinical characteristics, including total lymph nodes removed in either arm (RT alone vs RT+bicalutamide median 5 vs 6, p = 0.11). There was no significant association between total lymph nodes and overall survival with both arms combined (HR = 1.00, 95% CI:0.97-1.03, p = 0.87) or in the individual arms alone (RT+Casodex: HR = 1.01, 95% CI:0.97-1.05, p = 0.65; RT+Placebo: HR = 0.98, 95% CI: 0.94-1.03, p = 0.45). There was also no significant association between total lymph nodes and disease-specific survival with both arms combined (HR = 1.00, 95% CI:0.95-1.04, p = 0.84) and in the arms alone (RT+Casodex: HR = 1.00, 95% CI:0.95-1.05, p = 0.92; RT+Placebo: HR = 0.99, 95% CI: 0.92-1.07, p = 0.86). In multivariable analysis performed on the two arms, Gleason score was the only feature associated with worse overall and disease-specific survival, seen only in the RT alone arm. Similar findings were seen when evaluating times to local and distant failure. Conclusions: Lymph node yield in NRG/RTOG 9601 did not show any association with adverse outcomes in the entire cohort, or in either treatment arm alone. The therapeutic benefit of an extensive lymph node dissection in this population remains uncertain. Clinical trial information: NCT00002874.
Collapse
Affiliation(s)
- Emily Chan
- University of California San Francisco, San Francisco, CA
| | - Stephanie L. Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Jeff Simko
- University of California San Francisco, San Francisco, CA
| | - Felix Y Feng
- Department of Urology, University of California, San Francisco, CA
| | | | | | - Jean-Paul Bahary
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | | | | | | | | | | | | | | | | | | | - Scott McGinnis
- Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, NC
| | | | - Lyudmila Demora
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | |
Collapse
|
3
|
Shipley WU, Pugh SL, Lukka HR, Major P, Heney NM, Grignon DA, Sartor O, Patel M, Bahary JP, Zietman AL, Pisansky TM, Zeitzer KL, Lawton CA, Feng FYC, Lovett RD, Balogh AG, Souhami L, Rosenthal SA, Kerlin K, Sandler HM. NRG Oncology/RTOG 9601, a phase III trial in prostate cancer patients: Anti-androgen therapy (AAT) with bicalutamide during and after salvage radiation therapy (RT) following radical prostatectomy (RP) and an elevated PSA. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3 Background: Previous reports suggested that AAT when combined with salvage RT following RP in patients may improve prostate cancer control outcomes. Methods: Post-RP patients with pT3pN0 or with pT2pN0 and positive margins who had or developed elevated PSA levels from 0.2 to 4.0 ng/ml were randomized on a phase III, double-blind, trial of RT + placebo (64.8 Gy in 36 fractions of 1.8 Gy) vs. RT + AAT (24 months bicalutamide, 150 mg daily) during and after RT. The primary end-point was overall survival. Trial design required 725 patients and provided 80% power to detect a reduction in death rate by at least 28.5% and a 1-sided significance level of 0.046. Results: From 3/98 to 3/03, 761 eligible patients (median age 65) were randomized to RT + AAT (384) or RT + placebo (377). 248 patients (33%) were pT2pN0 and 513 (67%) were pT3pN0. 671 (88%) had a PSA nadir after RP of < 0.5 ng/ml. 649 (85%) had an entry PSA value of <1.6, 112 patients (15%) had an entry PSA of 1.6-4. Median follow up was 12.6 years. Actuarial overall survival at 10 years was 82% for RT plus AAT and 78% for RT + placebo and a hazard ratio of 0.75 (95% CI: 0.58-0.98) with a 1-sided p value of 0.018 (2-sided p = 0.036). The 12-year incidence of PC central-reviewed deaths were 2.3% for RT + AAT and 7.5% for RT + placebo ( p< 0.001).The cumulative incidence of metastatic PC at 12 years was less in the RT + AAT arm, 14% (51 patients), vs. 23% (83 patients) in the RT + placebo arm (p < 0.001). Subgroup analyses of the relative benefits of the addition of AAT to RT are planned and will be presented. Late grade III and IV toxicity were similar in the AAT and placebo arms. The combined grade III and IV toxicities for RT + AAT and RT + placebo were: bladder 7.0% vs. 6.7%, bowel 2.7% vs. 1.6%. Gynecomastia differed significantly by treatment arm, 70% vs. 11%. Conclusions: 24 months of AAT using 150mg bicalutamide daily during and after salvage RT significantly improved long term overall survival and reduced the incidence of metastatic PC and PC death. Support: NCI grants U10CA21661, U10CA180868, U10CA180822, and U10CA37422 and AstraZeneca. Clinical trial information: NCT00002874.
Collapse
Affiliation(s)
| | - Stephanie L. Pugh
- Statistical Center, Radiation Therapy Oncology Group, Philadelphia, PA
| | | | - Pierre Major
- McMaster University, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, LA
| | | | - Jean-Paul Bahary
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal University, Montreal, QC, Canada
| | | | | | | | | | | | | | | | - Luis Souhami
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Kevin Kerlin
- Southeast Cancer Control Consortium, Goldsboro, NC
| | | |
Collapse
|
4
|
Hallemeier CL, Moughan J, Haddock MG, Herskovic AM, Minsky BD, Kim H, Major P, Gore E, Schnall MD, Zeitzer KL, Komaki R, Bush D, Jacob R, Garg M, Crane CH. Impact of radiotherapy duration on outcomes in patients with esophageal cancer treated with definitive concurrent radiotherapy and chemotherapy on RTOG trials 8501 and 9405. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.119] [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] [Indexed: 11/20/2022] Open
Abstract
119 Background: Radiotherapy (RT) interruptions have a negative impact on outcomes in many epithelial malignancies treated with definitive RT. The purpose of this study was to analyze the impact of RT duration on outcomes in patients (pts) with esophageal cancer treated with definitive chemoradiotherapy (CRT). Methods: Pts treated with definitive CRT on RTOG trials 8501 and 9405 were included. Separate analyses were performed in pts receiving standard dose (SD-CRT; 50 Gy + 5FU + cisplatin) and high dose (HD-CRT; 64.8 Gy + 5FU + cisplatin) CRT. Local (LF) and regional (RF) failure were estimated by the cumulative incidence method. Disease-free (DFS) and overall (OS) survival were estimated by the Kaplan-Meier method. Univariate (UVA) and multivariate (MVA) Cox proportional hazards models were utilized to examine for correlation between RT duration (< vs. ≥ median) with LF, RF, DFS and OS. Results: In the SD-CRT cohort (n=235), 96 pts (41%) had ≥ 1 RT interruption for a median of 3 (IQR 1-6) days. The median RT duration was 39 (IQR 37-43) days. In UVA and MVA, RT duration was not associated with LF, RF, DFS, or OS. Estimated outcome rates are in the table. In the HD-CRT cohort (n=107), 64 pts (60%) had ≥ 1 RT interruption for a median of 3.5 (IQR 2-7.5) days. The median RT duration was 52 (IQR 50-57) days. In UVA, RT duration ≥ 52 days was associated with a 33% reduction in risk of DFS failure (HR=0.66, 95% CI [0.44-0.98], p=0.039) and a 29% reduction in risk of death (HR=0.71, 95% CI [0.48-1.06], p=0.09). When excluding the 25 pts with RT dose < 64.8 Gy, RT duration was not associated with DFS or OS. Conclusions: In pts with esophageal cancer receiving definitive SD-CRT, an association between RT duration and outcomes was not observed. In pts receiving HD-CRT, longer RT duration was associated with improved DFS, which may have been due to a significant number of deaths at RT dose < 64.8 Gy. Supported by NCI U10 grants CA21661, CA180868, CA180822, CA37422. Clinical trial information: NCT00002631. [Table: see text]
Collapse
Affiliation(s)
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | | | | | - Bruce D. Minsky
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Pierre Major
- McMaster University, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | | | - Ritsuko Komaki
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Bush
- Loma Linda University Cancer Institute, Loma Linda, CA
| | - Rojymon Jacob
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Madhur Garg
- Montefiore Medical Center, Moses Campus, Bronx, NY
| | | |
Collapse
|
5
|
Roach M, Yan Y, Lawton CA, Hsu ICJ, Lustig RA, Jones CU, Rotman M, Zeitzer KL, Werner-Wasik M, Kim H, Thomas CR, Shipley WU, Sandler HM. Radiation Therapy Oncology Group (RTOG) 9413: Randomized trial comparing whole pelvic radiotherapy (WPRT) to prostate only (PORT) and neoadjuvant hormone therapy (NHT) to adjuvant hormone therapy (AHT). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
96 Background: RTOG 9413 demonstrated that NHT+WPRT improved progression-free survival (PFS) compared to NHT+PORT, WPRT+AHT and PORT+AHT. We update primary and secondary endpoints (SE): biochemical failure (BF), time to metastasis (Mets), prostate specific survival (PSS) and overall survival (OS). Methods: RTOG 9413 opened on April 1, 1995, and closed on June 1, 1999, with 1275 eligible pts who were required to have a risk of lymph node (LN) involvement >15% but LN-positive pts were ineligible. They were stratified by T Stage, GS (<7 vs 7-10) and PSA (>30 vs < 30ng/ml) and randomized to PORT +/- WPRT to 70 Gy and NHT or AHT. Hormonal therapy (HT) consisted of flutamide, and leuprolide or goserelin, monthly x 4 mos, beginning 2 mos before RT and continued until RT is completed (NHT) or beginning at the completion of RT (AHT). For this analysis PFS was defined as the first occurrence of local/regional or LN progression, Mets, BF (PSA nadir+2ng/mL), or death from any cause. PSS is defined as a death due to prostate cancer, treatment toxicity or unknown causes with local progression, Mets or BF. Results: For the entire cohort WPRT or NHT did not appear to improve any endpoint compared with PORT or AHT, (although there was a trend for improvement in regional failure for WPRT vs PORT, (p=0.07)). However, there were complex sequence/volume dependent interactions between HT and RT and statistically significant differences between the 4 arms in PFS (p=0.03). There was a trend for NHT+WPRT to improved PFS compared to NHT+PO (p=0.07) and WPRT+AHT (p=0.04). NHT+WPRT was associated with an increased risk of late GI toxicity, 5% compared to 0.6%, 2% and 2% for NHT+PORT, WPRT+AHT and PORT+AHT (p<0.001) but not in GU late toxicity. Conclusions: The failure to improve SE or definitively impact PFS may reflect sample size, pt selection, and inadequate RT doses. RTOG 0924 will test the hypotheses that modern techniques and doses will improve OS without increasing late toxicity.
Collapse
Affiliation(s)
- Mack Roach
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Yan Yan
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Colleen Anne Lawton
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - I-Chow Joe Hsu
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Robert A. Lustig
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Christopher U. Jones
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Marvin Rotman
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Kenneth Lee Zeitzer
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Maria Werner-Wasik
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Harold Kim
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Charles R. Thomas
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - William U. Shipley
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Howard Mark Sandler
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| |
Collapse
|