Berardino De Bari1,2, Bradley Stish3, Mark Wayne Ball4, Yacob Habboush5, Paul Sargos6, Marco Krengli7, Alberto Bossi8, Armando Stabile9, Claudio Sole Pesutic10, Laëtitia Lestrade1,11, Robert Jan Smeenk12, Barbara Alicja Jereczek-Fossa13,14, Thomas Zilli11, Gilles Créhange15, Filippo Alongi16, Nicholas Zaorsky17, Mahmut Ozsahin2. 1. Department of Radiation Oncology, Centre Hospitalier Régional Universitaire "Jean Minjoz", INSERM, UMR1098, Besançon, France. 2. Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 3. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. 4. Department of Urology, Johns Hopkins University School of Medicine, Bethesda, Maryland. 5. Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida. 6. Department of Radiation Oncology, Institut Bergonie, Bordeaux, France. 7. Department of Radiation Oncology, University Hospital Maggiore della Carità, Novara, Italy. 8. Department of Radiation Oncology, Institut Gustave Roussy, Paris, France. 9. Department of Urology, San Raffaele Hospital, Milan, Italy. 10. Facultad de Medicina, Department of Radiation Oncology, Clínica IRAM, Universitad "Diego Portales", Santiago, Chile. 11. Department of Radiation Oncology, Hôpitaux Universitaires De Genève, Geneva, Switzerland. 12. Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands. 13. Department of Radiation Oncology, European Institute of Oncology, Milan, Italy. 14. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. 15. Department of Radiation Oncology, Centre Georges-François-Leclerc, CNRS, UMR6306 Le2i, Dijon, France. 16. Department of Radiation Oncology, Ospedale Sacro Cuore-Don Calabria, Cancer Care Center, Negrar, Italy. 17. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Abstract
INTRODUCTION: Adult prostatic sarcoma (PS) is a rare disease. While surgery is considered the standard approach, the role of other therapies is not completely established. We report results of the largest multicentric contemporary cohort of PS patients. MATERIALS AND METHODS: This study included 61 adult PS patients treated in 16 American and European Institutions. Median age was 64.4 years (range: 22-87). Curative surgery was delivered in 48 patients (prostatectomy = 26, cystoprostatectomy = 22), usually with lymphadenectomy (n = 40). Curative radiotherapy (RT) was delivered in 32 patients, as radical (n = 5), neoadjuvant (n = 10), or postoperative treatment (n = 17). Eighteen patients received chemotherapy. None of the patients received hormonal therapy. RESULTS: Median follow-up was 72 months (95%CI: 55-not reached). Five-year local control (LC), overall survival (OS), cancer-specific survival, disease-free survival, and metastases-free rates were 47%, 53%, 56%, 35%, and 35%, respectively. Notably, curative RT (neoadjuvant, adjuvant, or definitive) was associated with improved 5-year LC (55% vs. 31%, P = 0.02) and OS (59% vs. 46%, P = 0.1). Surgically treated patients presenting with a cT3-4 tumor (n = 31), who received RT (n = 24), had a significantly improved 5-year LC (68% vs, 33%, P = 0.004) and OS (65% vs. 21%, P < 0.001) rates compared to patients not receiving RT. cT4 patients demonstrated a significantly lower 5-year OS (43% vs. 61%, P = 0.006) and LC (29% vs. 69%, P < 0.001) rates. Histologic subtype was not associated with LC and OS, but patients with prostatic stromal sarcoma, rhabdomyosarcoma, or sarcomatoid carcinoma had worse 5-year LC compared to other types (47% vs. 55%) and OS (49% vs. 58%). CONCLUSION: Adult PS has a poor prognosis. Locally advanced tumors have poor LC and OS rates. Curative RT should be considered part of the multidisciplinary approach to PS.
INTRODUCTION: Adult prostatic sarcoma (PS) is a rare disease. While surgery is considered the standard approach, the role of other therapies is not completely established. We report results of the largest multicentric contemporary cohort of PS patients. MATERIALS AND METHODS: This study included 61 adult PS patients treated in 16 American and European Institutions. Median age was 64.4 years (range: 22-87). Curative surgery was delivered in 48 patients (prostatectomy = 26, cystoprostatectomy = 22), usually with lymphadenectomy (n = 40). Curative radiotherapy (RT) was delivered in 32 patients, as radical (n = 5), neoadjuvant (n = 10), or postoperative treatment (n = 17). Eighteen patients received chemotherapy. None of the patients received hormonal therapy. RESULTS: Median follow-up was 72 months (95%CI: 55-not reached). Five-year local control (LC), overall survival (OS), cancer-specific survival, disease-free survival, and metastases-free rates were 47%, 53%, 56%, 35%, and 35%, respectively. Notably, curative RT (neoadjuvant, adjuvant, or definitive) was associated with improved 5-year LC (55% vs. 31%, P = 0.02) and OS (59% vs. 46%, P = 0.1). Surgically treated patients presenting with a cT3-4 tumor (n = 31), who received RT (n = 24), had a significantly improved 5-year LC (68% vs, 33%, P = 0.004) and OS (65% vs. 21%, P < 0.001) rates compared to patients not receiving RT. cT4 patients demonstrated a significantly lower 5-year OS (43% vs. 61%, P = 0.006) and LC (29% vs. 69%, P < 0.001) rates. Histologic subtype was not associated with LC and OS, but patients with prostatic stromal sarcoma, rhabdomyosarcoma, or sarcomatoid carcinoma had worse 5-year LC compared to other types (47% vs. 55%) and OS (49% vs. 58%). CONCLUSION: Adult PS has a poor prognosis. Locally advanced tumors have poor LC and OS rates. Curative RT should be considered part of the multidisciplinary approach to PS.
Authors: Jonathan D Tward; Matthew M Poppe; Ying J Hitchcock; Brock O'Neil; Daniel J Albertson; Dennis C Shrieve Journal: Cancer Med Date: 2018-11-19 Impact factor: 4.452