Christopher R King1. 1. Department of Radiation Oncology, UCLA School of Medicine, Los Angeles, United States. Electronic address: crking@mednet.ucla.edu.
Abstract
PURPOSE/ OBJECTIVES: To date neither the optimal radiotherapy dose nor the existence of a dose-response has been established for salvage RT (SRT). MATERIALS/ METHODS: A systematic review from 1996 to 2015 and meta-analysis was performed to identify the pathologic, clinical and treatment factors associated with relapse-free survival (RFS) after SRT (uniformly defined as a PSA>0.2ng/mL or rising above post-SRT nadir). A sigmoidal dose-response curve was objectively fitted and a non-parametric statistical test used to determine significance. RESULTS: 71 studies (10,034 patients) satisfied the meta-analysis criteria. SRT dose (p=0.0001), PSA prior to SRT (p=0.0009), ECE+ (p=0.039) and SV+ (p=0.046) had significant associations with RFS. Statistical analyses confirmed the independence of SRT dose-response. Omission of series with ADT did not alter results. Dose-response is well fit by a sigmoidal curve (p=0.0001) with a TCD50 of 65.8Gy, with a dose of 70Gy achieving 58.4% RFS vs. 38.5% for 60Gy. A 2.0% [95% CI 1.1-3.2] improvement in RFS is achieved for each Gy. The SRT dose-response remarkably parallels that for definitive RT of localized disease. CONCLUSIONS: This study provides level 2a evidence for dose-escalated SRT>70Gy. The presence of an SRT dose-response for microscopic disease supports the hypothesis that prostate cancer is inherently radio-resistant. Copyright Â
PURPOSE/ OBJECTIVES: To date neither the optimal radiotherapy dose nor the existence of a dose-response has been established for salvage RT (SRT). MATERIALS/ METHODS: A systematic review from 1996 to 2015 and meta-analysis was performed to identify the pathologic, clinical and treatment factors associated with relapse-free survival (RFS) after SRT (uniformly defined as a PSA>0.2ng/mL or rising above post-SRT nadir). A sigmoidal dose-response curve was objectively fitted and a non-parametric statistical test used to determine significance. RESULTS: 71 studies (10,034 patients) satisfied the meta-analysis criteria. SRT dose (p=0.0001), PSA prior to SRT (p=0.0009), ECE+ (p=0.039) and SV+ (p=0.046) had significant associations with RFS. Statistical analyses confirmed the independence of SRT dose-response. Omission of series with ADT did not alter results. Dose-response is well fit by a sigmoidal curve (p=0.0001) with a TCD50 of 65.8Gy, with a dose of 70Gy achieving 58.4% RFS vs. 38.5% for 60Gy. A 2.0% [95% CI 1.1-3.2] improvement in RFS is achieved for each Gy. The SRT dose-response remarkably parallels that for definitive RT of localized disease. CONCLUSIONS: This study provides level 2a evidence for dose-escalated SRT>70Gy. The presence of an SRT dose-response for microscopic disease supports the hypothesis that prostate cancer is inherently radio-resistant. Copyright Â
Authors: Jeremie Calais; Johannes Czernin; Minsong Cao; Amar U Kishan; John V Hegde; Narek Shaverdian; Kiri Sandler; Fang-I Chu; Chris R King; Michael L Steinberg; Isabel Rauscher; Nina-Sophie Schmidt-Hegemann; Thorsten Poeppel; Philipp Hetkamp; Francesco Ceci; Ken Herrmann; Wolfgang P Fendler; Matthias Eiber; Nicholas G Nickols Journal: J Nucl Med Date: 2017-11-09 Impact factor: 10.057
Authors: Nina-Sophie Schmidt-Hegemann; Chukwuka Eze; Minglun Li; Paul Rogowski; Christian Schaefer; Christian Stief; Alexander Buchner; Constantinos Zamboglou; Wolfgang Peter Fendler; Ute Ganswindt; Clemens Cyran; Peter Bartenstein; Claus Belka; Harun Ilhan Journal: J Nucl Med Date: 2018-12-14 Impact factor: 10.057
Authors: Pirus Ghadjar; Daniel M Aebersold; Clemens Albrecht; Dirk Böhmer; Michael Flentje; Ute Ganswindt; Stefan Höcht; Tobias Hölscher; Felix Sedlmayer; Frederik Wenz; Daniel Zips; Thomas Wiegel Journal: Strahlenther Onkol Date: 2018-01-30 Impact factor: 3.621
Authors: Ovidiu Gabriel Bratu; Camelia Cristina Diaconu; Dan Liviu Dorel Mischianu; Traian Constantin; Ana Maria Alexandra Stanescu; Simona Gabriela Bungau; Florentina Ionita-Radu; Radu Dragos Marcu Journal: Exp Ther Med Date: 2019-08-20 Impact factor: 2.447
Authors: Nina-Sophie Schmidt-Hegemann; Christian Stief; Tak-Hyun Kim; Chukwuka Eze; Simon Kirste; Iosif Strouthos; Minglun Li; Wolfgang Schultze-Seemann; Harun Ilhan; Wolfgang Peter Fendler; Peter Bartenstein; Anca-Ligia Grosu; Ute Ganswindt; Claus Belka; Philipp T Meyer; Constantinos Zamboglou Journal: J Nucl Med Date: 2018-07-12 Impact factor: 10.057