Local Failure and Survival After Definitive Radiotherapy for Aggressive Prostate Cancer: An Individual Patient-level Meta-analysis of Six Randomized Trials

Publication date: Available online 10 November 2019Source: European UrologyAuthor(s): Amar U. Kishan, Fang-I Chu, Christopher R. King, Wendy Seiferheld, Daniel E. Spratt, Phuoc Tran, Xiaoyan Wang, Stephanie E. Pugh, Kiri A. Sandler, Michel Bolla, Philippe Maingon, Theo De Reijke, Nicholas G. Nickols, Matthew Rettig, Alexandra Drakaki, Sandy T. Liu, Robert E. Reiter, Albert J. Chang, Felix Y. Feng, Dipti SajedAbstractBackgroundThe importance of local failure (LF) after treatment of high-grade prostate cancer (PCa) with definitive radiotherapy (RT) remains unknown.ObjectiveTo evaluate the clinical implications of LF after definitive RT.Design, setting, and participantsIndividual patient data meta-analysis of 992 patients (593 Gleason grade group [GG] 4 and 399 GG 5) enrolled in six randomized clinical trials.Outcome measurements and statistical analysisMultivariable Cox proportional hazard models were developed to evaluate the relationship between overall survival (OS), PCa-specific survival (PCSS), and distant metastasis (DM)-free survival (DMFS) and LF as a time-dependent covariate. Markov proportional hazard models were developed to evaluate the impact of specific transitions between disease states on these endpoints.Results and limitationsMedian follow-up was 6.4 yr overall and 7.2 yr for surviving patients. LF was significantly associated with OS (hazard ratio [HR] 1.70 [95% confidence interval {CI} 1.37–2.10]), PCSS (3.10 [95% CI 2.33–4.12]), and DMFS (HR ...
Source: European Urology - Category: Urology & Nephrology Source Type: research

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ConclusionsMaxillofacial manifestation of bone metastasis is common but is often overlooked. Therefore, it should be considered in the differential diagnosis when a patient with a history of antiresorptive medications presents with a gingival mass and/or exophytic bone. Good clinical judgment and well-timed bone biopsy and diagnostic imaging can lead to the correct diagnosis and optimal treatment.
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology - Category: ENT & OMF Source Type: research
Conclusions: Hypofractionated radiotherapy appears to be equally tolerated compared to conventional fractionation in the early setting. Longer follow up is needed to assess the late toxicity profile of the patients and any potential differences between the control and experimental arm.
Source: Journal of Cancer - Category: Cancer & Oncology Authors: Tags: Research Paper Source Type: research
For patients with unfavorable or high-risk prostate cancer, dose escalated radiation therapy leads to improved progression free survival but attempts to deliver increased dose by external beam radiation therapy (EBRT) alone can be limited by late toxicities to nearby genitourinary and gastrointestinal organs at risk. Brachytherapy is a method to deliver dose escalation in conjunction with EBRT with a potentially improved late toxicity profile and improved prostate cancer related outcomes. At least three randomized controlled trials have demonstrated improved biochemical control with the addition of either low-dose rate (LD...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Conditions:   Metastatic Prostate Adenocarcinoma;   Prostate Adenocarcinoma;   Recurrent Prostate Carcinoma;   Stage IV Prostate Cancer AJCC v8;   Stage IVA Prostate Cancer AJCC v8;   Stage IVB Prostate Cancer AJCC v8 Interventions:   Radiation: Intensity-Modulated Radiation Therapy;   Radiation: Proton Beam Radiation Therapy;   Other: Quality-of-Life Assessment;   Other: Questionnaire Administration Sponsors:   Mayo...
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Abstract PURPOSE: Knowledge-based planning (KBP) techniques have been reported to improve plan quality, efficiency, and consistency in radiation therapy. However, plan complexity and deliverability have not been addressed previously for treatment plans guided by an established in-house KBP system. The purpose of this work was to assess dosimetric, mechanical, and delivery properties of plans designed with a common KBP method for prostate cases treated via volumetric modulated arc therapy (VMAT). METHODS: Thirty-one prostate patients previously treated with VMAT were replanned with an in-house KBP method based...
Source: Journal of Applied Clinical Medical Physics - Category: Physics Authors: Tags: J Appl Clin Med Phys Source Type: research
ConclusionIMRT at a dose up to 78  Gy combined with short-term neoadjuvant ADT resulted in excellent long-term disease-free outcomes with acceptable morbidities among patients with IR PCa. In addition, the incidence of late recurrence was very low. Further investigation is warranted to confirm our findings.
Source: International Journal of Clinical Oncology - Category: Cancer & Oncology Source Type: research
We present 3 cases with false-negatives for local (recurrent) prostate cancer on 68Ga-PSMA PET/CT, using multiparametric MRI and histopathology as reference standard. Metal artifact of prostate gold markers placed for external beam radiation therapy, low level of PSMA uptake, and bladder spillover are potential causes of misinterpretation. Awareness of these diagnostic pitfalls may improve 68Ga-PSMA PET/CT interpretation.
Source: Clinical Nuclear Medicine - Category: Nuclear Medicine Tags: Interesting Images Source Type: research
American Journal of Roentgenology, Ahead of Print.
Source: American Journal of Roentgenology - Category: Radiology Authors: Source Type: research
CONCLUSIONS: In men receiving definitive RT for intermediate- or high-risk PCa, CAB was not associated with improved PCSM or OS compared with GnRH alone. PMID: 31805534 [PubMed - in process]
Source: Journal of the National Comprehensive Cancer Network : JNCCN - Category: Cancer & Oncology Tags: J Natl Compr Canc Netw Source Type: research
American Journal of Roentgenology, Ahead of Print.
Source: American Journal of Roentgenology - Category: Radiology Authors: Source Type: research
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