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Crook J, Rodgers J, Pisansky T, Trabulsi E, Amin M, Bice W, Morton G, Pervez N, Vigneault E, Catton C, Michalski J, Roach M, Beyer D, Rossi P, Horwitz E, Donavanik V, Sandler H. Salvage Low Dose Rate Prostate Brachytherapy: Clinical Outcomes of a Phase II Trial for Local Recurrence after External Beam Radiotherapy (NRG/RTOG -0526). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rodgers J, Crook J, Pisansky T, Trabulsi E, Amin M, Bice W, Morton G, Pervez N, Vigneault E, Catton C, Michalski J, Roach M, Beyer D, Rossi P, Horwitz E, Donavanik V, Sandler H. 10: NCI Salvage Low Dose Rate Prostate Brachytherapy: Clinical Outcomes of a Phase II Trial for Local Recurrence after External Beam Radiotherapy (NRG/RTOG 0526). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30902-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bruner D, Moughan J, Prestidge B, Sanda M, Bice W, Michalski J, Ibbott G, Amin M, Catton C, Donavanik V, Gay H, Brachman D, Frank S, Rosenthal S, Matulonis U, Sadeghi A, Winter K, Sandler H, Papagikos M. Patient Reported Outcomes of NRG Oncology/RTOG 0232: A Phase III Study Comparing Combined External Beam Radiation and Transperineal Interstitial Permanent Brachytherapy with Brachytherapy Alone in Intermediate Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Crook JM, Zhang P, Pisansky TM, Trabulsi EJ, Amin MB, Bice W, Morton G, Pervez N, Vigneault E, Catton C, Michalski J, Roach M, Beyer D, Jani A, Horwitz E, Donavanik V, Sandler H. A Prospective Phase 2 Trial of Transperineal Ultrasound-Guided Brachytherapy for Locally Recurrent Prostate Cancer After External Beam Radiation Therapy (NRG Oncology/RTOG-0526). Int J Radiat Oncol Biol Phys 2018; 103:335-343. [PMID: 30312717 DOI: 10.1016/j.ijrobp.2018.09.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Only retrospective data are available for low-dose-rate (LDR) salvage prostate brachytherapy for local recurrence after external beam radiation therapy (EBRT). The primary objective of this prospective phase 2 trial (NCT00450411) was to evaluate late gastrointestinal and genitourinary adverse events (AEs) after salvage LDR brachytherapy. METHODS AND MATERIALS Eligible patients had low- or intermediate-risk prostate cancer before EBRT and biopsy-proven recurrence >30 months after EBRT, with prostate-specific antigen levels <10 ng/mL and no regional/distant disease. The primary endpoint was grade 3 or higher late treatment-related gastrointestinal or genitourinary AEs occurring 9 to 24 months after brachytherapy. These AEs were projected to be ≤10%, with ≥20% considered unacceptable. All events were graded with National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Multivariate analyses investigated associations of pretreatment or treatment variables with AEs. RESULTS One hundred patients from 20 centers were registered from May 2007 to January 2014. The 92 analyzable patients had a median follow-up of 54 months (range, 4-97) and a median age of 70 years (interquartile range [IQR], 65-74). The initial Gleason score was 7 in 48% of patients. The median dose of EBRT was 74 Gy (IQR, 70-76) at a median interval of 85 months previously (IQR, 60-119). Only 16% had androgen deprivation at study entry. Twelve patients (14%) had late grade 3 gastrointestinal/genitourinary AEs, with no treatment-related grade 4 or 5 AEs. No pretreatment variable predicted late AEs, including prior EBRT dose and elapsed interval. Higher V100 (percentage of prostate enclosed by prescription isodose) predicted both occurrence of late AEs (odds ratio, 1.24; 95% confidence interval, 1.02-1.52; P = .03) and earlier time to first occurrence (hazard ratio, 1.18; 95% CI, 1.03-1.34; P = .02). CONCLUSIONS This prospective multicenter trial reports outcomes of salvage LDR brachytherapy for post-EBRT recurrence. The rate of late grade 3 AEs did not exceed the unacceptable threshold. The only factor predictive of late AEs was implant dosimetry reflected by V100. Efficacy outcomes will be reported at a minimum of 5-year follow-up.
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Affiliation(s)
- Juanita M Crook
- BC Cancer Agency and University of British Columbia, Kelowna, British Columbia, Canada.
| | - Peixin Zhang
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
| | | | | | - Mahul B Amin
- Cedars-Sinai Medical Center, Los Angeles, California
| | - William Bice
- John Muir Health Systems, Walnut Creek, California
| | - Gerard Morton
- Odette Cancer Center/University of Toronto, Toronto, Ontario, Canada
| | | | | | - Charles Catton
- University Health Network/University of Toronto, Toronto, Ontario, Canada
| | | | - Mack Roach
- University of California, San Francisco, San Francisco, California
| | - David Beyer
- Arizona Oncology Services Foundation, Sedona, Arizona
| | | | - Eric Horwitz
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Crook J, Zhang P, Pisansky T, Amin M, Bice W, Morton G, Catton C, Michalski J, Roach M, Beyer D, Horwitz E, Rossi P, Vigneault E, Trabulsi E, Pervez N, Donavanik V, Sandler H. A Prospective Phase 2 Trial of Transperineal Ultrasound-Guided Brachytherapy for Locally Recurrent Prostate Cancer after External Beam Radiation Therapy (NRG/RTOG0526): Initial Report of Late Toxicity Outcome. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Prestidge B, Winter K, Sanda M, Amin M, Bice W, Michalski J, Ibbott G, Crook J, Catton C, Gay H, Donavanik V, Beyer D, Frank S, Papagikos M, Rosenthal S, Barthold H, Roach M, Sandler H. Initial Report of NRG Oncology/RTOG 0232: A Phase 3 Study Comparing Combined External Beam Radiation and Transperineal Interstitial Permanent Brachytherapy With Brachytherapy Alone for Selected Patients With Intermediate-Risk Prostatic Carcinoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rosenthal SA, Hunt D, Sartor AO, Pienta KJ, Gomella L, Grignon D, Rajan R, Kerlin KJ, Jones CU, Dobelbower M, Shipley WU, Zeitzer K, Hamstra DA, Donavanik V, Rotman M, Hartford AC, Michalski J, Seider M, Kim H, Kuban DA, Moughan J, Sandler H. A Phase 3 Trial of 2 Years of Androgen Suppression and Radiation Therapy With or Without Adjuvant Chemotherapy for High-Risk Prostate Cancer: Final Results of Radiation Therapy Oncology Group Phase 3 Randomized Trial NRG Oncology RTOG 9902. Int J Radiat Oncol Biol Phys 2015. [PMID: 26209502 DOI: 10.1016/j.ijrobp.2015.05.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Long-term (LT) androgen suppression (AS) with radiation therapy (RT) is a standard treatment of high-risk, localized prostate cancer (PCa). Radiation Therapy Oncology Group 9902 was a randomized trial testing the hypothesis that adjuvant combination chemotherapy (CT) with paclitaxel, estramustine, and oral etoposide plus LT AS plus RT would improve overall survival (OS). METHODS AND MATERIALS Patients with high-risk PCa (prostate-specific antigen 20-100 ng/mL and Gleason score [GS] ≥ 7 or clinical stage ≥ T2 and GS ≥ 8) were randomized to RT and AS (AS + RT) alone or with adjuvant CT (AS + RT + CT). CT was given as four 21-day cycles, delivered beginning 28 days after 70.2 Gy of RT. AS was given as luteinizing hormone-releasing hormone for 24 months, beginning 2 months before RT plus an oral antiandrogen for 4 months before and during RT. The study was designed based on a 6% improvement in OS from 79% to 85% at 5 years, with 90% power and a 2-sided alpha of 0.05. RESULTS A total of 397 patients (380 eligible) were randomized. The patients had high-risk PCa, 68% with GS 8 to 10 and 34% T3 to T4 tumors, and median prostate-specific antigen of 22.6 ng/mL. The median follow-up period was 9.2 years. The trial closed early because of excess thromboembolic toxicity in the CT arm. The 10-year results for all randomized patients revealed no significant difference between the AS + RT and AS + RT + CT arms in OS (65% vs 63%; P=.81), biochemical failure (58% vs 54%; P=.82), local progression (11% vs 7%; P=.09), distant metastases (16% vs 14%; P=.42), or disease-free survival (22% vs 26%; P=.61). CONCLUSIONS NRG Oncology RTOG 9902 showed no significant differences in OS, biochemical failure, local progression, distant metastases, or disease-free survival with the addition of adjuvant CT to LT AS + RT. The trial results provide valuable data regarding the natural history of high-risk PCa treated with LT AS + RT and have implications for the feasibility of clinical trial accrual and tolerability using CT for PCa.
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Affiliation(s)
- Seth A Rosenthal
- Radiation Oncology, Sutter Cancer Centers, Roseville, California.
| | - Daniel Hunt
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | - Leonard Gomella
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | - Kevin J Kerlin
- Community Clinical Oncology Program, Southeast Cancer Control Consortium, Inc, Winston-Salem, North Carolina
| | - Christopher U Jones
- Radiation Oncology, Sutter Cancer Centers, Roseville, California; Radiological Associates of Sacramento, Sacramento, California
| | | | - William U Shipley
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Marvin Rotman
- State University of New York Health Science Center-Brooklyn, Brooklyn, New York
| | | | | | | | - Harold Kim
- Wayne State University, Detroit, Michigan
| | - Deborah A Kuban
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Krauss DJ, Hu C, Bahary JP, Souhami L, Gore EM, Chafe SMJ, Leibenhaut MH, Narayan S, Torres-Roca J, Michalski J, Zeitzer KL, Donavanik V, Sandler H, McGowan DG, Jones CU, Shipley WU. Importance of Local Control in Early-Stage Prostate Cancer: Outcomes of Patients With Positive Post-Radiation Therapy Biopsy Results Treated in RTOG 9408. Int J Radiat Oncol Biol Phys 2015; 92:863-73. [PMID: 26104939 DOI: 10.1016/j.ijrobp.2015.03.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to assess the association between positive post-radiation therapy (RT) biopsy results and subsequent clinical outcomes in males with localized prostate cancer. METHODS AND MATERIALS Radiation Therapy Oncology Group study 94-08 analyzed 1979 males with prostate cancer, stage T1b-T2b and prostate-specific antigen concentrations of ≤ 20 ng/dL, to investigate whether 4 months of total androgen suppression (TAS) added to RT improved survival compared to RT alone. Patients randomized to receive TAS received flutamide with luteinizing hormone releasing hormone (LHRH) agonist. According to protocol, patients without evidence of clinical recurrence or initiation of additional endocrine therapy underwent repeat prostate biopsy 2 years after RT completion. Statistical analysis was performed to evaluate the impact of positive post-RT biopsy results on clinical outcomes. RESULTS A total of 831 patients underwent post-RT biopsy, 398 were treated with RT alone and 433 with RT plus TAS. Patients with positive post-RT biopsy results had higher rates of biochemical failure (hazard ratio [HR] = 1.7; 95% confidence interval [CI] = 1.3-2.1) and distant metastasis (HR = 2.4; 95% CI = 1.3-4.4) and inferior disease-specific survival (HR = 3.8; 95% CI = 1.9-7.5). Positive biopsy results remained predictive of such outcomes after correction for potential confounders such as Gleason score, tumor stage, and TAS administration. Prior TAS therapy did not prevent elevated risk of adverse outcome in the setting of post-RT positive biopsy results. Patients with Gleason score ≥ 7 with a positive biopsy result additionally had inferior overall survival compared to those with a negative biopsy result (HR = 1.56; 95% CI = 1.04-2.35). CONCLUSIONS Positive post-RT biopsy is associated with increased rates of distant metastases and inferior disease-specific survival in patients treated with definitive RT and was associated with inferior overall survival in patients with high-grade tumors.
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Affiliation(s)
- Daniel J Krauss
- Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
| | - Chen Hu
- NRG Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Jean-Paul Bahary
- Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal, Quebec, Canada
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Sarkar A, Donavanik V, Zhang I, Chen H, Koprowski C, Hanlon A, Mourtada F, Strasser J, Raben A. Prostate implant dosimetric outcomes and migration patterns between bio-absorbable coated and uncoated brachytherapy seeds. Brachytherapy 2013; 12:356-61. [PMID: 23477885 DOI: 10.1016/j.brachy.2013.01.163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/21/2012] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Abhirup Sarkar
- Department of Radiation Oncology, Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE
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Sarkar A, Raben A, Chen H, Donavanik V. Dosimetric Comparison Between New Bio-Absorbable Polymer Coated Anchor Seeds And Loose Uncoated Seeds In PSI Of The Prostate. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Benge B, Donavanik V, Sammons S, Glick A, Sarkar A, Townsend M, Hanlon A, Koprowski P, Raben A, Kattepogu K. 5 year clinical outcomes for organ confined low, intermediate, and high risk prostate cancer treated with PSI +/- ERT: the Christiana Health Care experience. Del Med J 2009; 81:189-193. [PMID: 19634632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Bruce Benge
- Urology Consultants in Wilmington, Delaware, USA
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Rudoler SB, Donavanik V. Squamous cell carcinoma of the true vocal cord: outcome following definitive external beam radiation therapy. Del Med J 1997; 69:153-4. [PMID: 9110508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Amornmarn R, Prempree T, Viravathana T, Donavanik V, Wizenberg MJ. A therapeutic approach to early vocal cord carcinoma. Acta Radiol Oncol 1985; 24:321-5. [PMID: 2994388 DOI: 10.3109/02841868509136059] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
One hundred and twenty patients with early glottic carcinoma received radiation therapy at the University of Maryland Hospital from 1959 to 1977. The radiation dose ranged from 55 Gy in 4 weeks for small T1a lesions to 65 Gy in 61/2 weeks for T2 lesions. The local control rates by irradiation alone for stages T1a, T1b, and T2 were 92, 91 and 88 per cent, respectively, while 5-year determinate disease-free survival rates were 96 per cent for stage I disease and 88 per cent for stage II disease. Most of the local failures were salvaged by surgery, with a low complication rate. Regional metastases were uncommon, and occurred in 7 per cent in stage I and in 6 per cent in stage II disease. Factors increasing the risk of failures appeared to be bulky tumor, anterior commissure involvement and subglottic extension.
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