Stephen J Ramey1, Shree Agrawal2, Matthew C Abramowitz3, Drew Moghanaki4, Thomas M Pisansky5, Jason A Efstathiou6, Jeff M Michalski7, Daniel E Spratt8, Jason W D Hearn8, Bridget F Koontz9, Stanley L Liauw10, Alan Pollack1, Mitchell S Anscher11, Robert B Den12, Kevin L Stephans13, Anthony L Zietman6, W Robert Lee9, Andrew J Stephenson13, Rahul D Tendulkar13. 1. University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA. 2. Case Western Reserve University School of Medicine, Cleveland, OH, USA. 3. University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA. Electronic address: mabramowitz@med.miami.edu. 4. Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA; Virginia Commonwealth University Medical Center, Richmond, VA, USA. 5. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA. 6. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 7. Washington University School of Medicine, St. Louis, MO, USA. 8. University of Michigan, Ann Arbor, MI, USA. 9. Duke University Medical Center, Durham, NC, USA. 10. University of Chicago, Chicago, IL, USA. 11. Virginia Commonwealth University Medical Center, Richmond, VA, USA. 12. Sidney Kimmel Medical College at Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, PA, USA. 13. Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND: Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT). OBJECTIVE: To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM). DESIGN, SETTING, AND PARTICIPANTS: A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo. INTERVENTIONS: WPRT and/or ADT in addition to PBRT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression. RESULTS AND LIMITATION: Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p<0.001) and no ADT versus ADT (HR 1.70, p<0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% (p<0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p=0.012). No significant differences in DM cumulative incidence were found. CONCLUSIONS: For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival. PATIENT SUMMARY: We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning).
BACKGROUND: Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT). OBJECTIVE: To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM). DESIGN, SETTING, AND PARTICIPANTS: A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo. INTERVENTIONS:WPRT and/or ADT in addition to PBRT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression. RESULTS AND LIMITATION: Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p<0.001) and no ADT versus ADT (HR 1.70, p<0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% (p<0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p=0.012). No significant differences in DM cumulative incidence were found. CONCLUSIONS: For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival. PATIENT SUMMARY: We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning).
Authors: A Bruni; G Ingrosso; F Trippa; M Di Staso; B Lanfranchi; L Rubino; S Parente; L Frassinelli; E Maranzano; R Santoni; M C Sighinolfi; F Lohr; E Mazzeo Journal: Clin Transl Oncol Date: 2019-03-13 Impact factor: 3.405
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Authors: Giovanna Mantini; Giambattista Siepe; Anna Rita Alitto; Milly Buwenge; Nam P Nguyen; Andrea Farioli; Riccardo Schiavina; Francesco Catucci; Francesco Deodato; Bruno Fionda; Vincenzo Frascino; Gabriella Macchia; Maria Ntreta; Gilbert D A Padula; Alessandra Arcelli; Silvia Cammelli; Giuseppe Zanirato Rambaldi; Savino Cilla; Vincenzo Valentini; Alessio G Morganti Journal: Prostate Cancer Prostatic Dis Date: 2018-07-23 Impact factor: 5.554