scholarly journals Radiotherapy in nodal oligorecurrent prostate cancer

2021 ◽  
Author(s):  
Michael Pinkawa ◽  
Daniel M. Aebersold ◽  
Dirk Böhmer ◽  
Michael Flentje ◽  
Pirus Ghadjar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Literature Review ◽  
Survival Rates ◽  
Local Treatment ◽  
Progression Free Survival ◽  
Nodal Metastasis ◽  
Stereotactic Ablative Radiotherapy ◽  
Current Standard ◽  
Free Survival ◽  
Systemic Treatments

Abstract Objective The current article encompasses a literature review and recommendations for radiotherapy in nodal oligorecurrent prostate cancer. Materials and methods A literature review focused on studies comparing metastasis-directed stereotactic ablative radiotherapy (SABR) vs. external elective nodal radiotherapy (ENRT) and studies analyzing recurrence patterns after local nodal treatment was performed. The DEGRO Prostate Cancer Expert Panel discussed the results and developed treatment recommendations. Results Metastasis-directed radiotherapy results in high local control (often > 90% within a follow-up of 1–2 years) and can be used to improve progression-free survival or defer androgen deprivation therapy (ADT) according to prospective randomized phase II data. Distant progression after involved-node SABR only occurs within a few months in the majority of patients. ENRT improves metastases-free survival rates with increased toxicity in comparison to SABR according to retrospective comparative studies. The majority of nodal recurrences after initial local treatment of pelvic nodal metastasis are detected within the true pelvis and common iliac vessels. Conclusion ENRT with or without a boost should be preferred to SABR in pelvic nodal recurrences. In oligometastatic prostate cancer with distant (extrapelvic) nodal recurrences, SABR alone can be performed in selected cases. Application of additional systemic treatments should be based on current guidelines, with ADT as first-line treatment for hormone-sensitive prostate cancer. Only in carefully selected patients can radiotherapy be initially used without additional ADT outside of the current standard recommendations. Results of (randomized) prospective studies are needed for definitive recommendations.

Stereotactic ablative radiation therapy for the treatment of oligometastatic prostate cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5020-5020 ◽  
Author(s):  
Phuoc T. Tran ◽  
C. Leigh Moyer ◽  
Ryan Phillips ◽  
Noura Radwan ◽  
Ashley Ross ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Outcomes ◽  
Local Treatment ◽  
Progression Free Survival ◽  
Stereotactic Ablative Radiotherapy ◽  
High Dose ◽  
Free Survival ◽  
Local Progression ◽  
Oligometastatic Prostate Cancer

5020 Background: The importance of local treatment in oligometastatic prostate cancer (OPC) is unknown. Stereotactic ablative radiotherapy (SABR) is highly focused, high-dose radiation that is well suited for treatment of oligometastases. Here we report on the safety and preliminary clinical outcomes of SABR in a modern cohort of OPC men. Methods: Eighty four men who satisfied criteria of OPC diagnosed on imaging underwent consolidative SABR were then followed prospectively on our IRB approved registry by our GU multidisciplinary team. We collected demographic, clinical, toxicity and efficacy information. We examined the first 66 men in this preliminary report to allow for a minimum of 4.5 months follow-up. SABR was delivered in 1-5 fractions of 5-18 Gy. Kaplan-Meier method was used to assess local progression-free survival (LPFS), biochemical progression-free survival (bPFS; PSA nadir+2), distant progression free survival (DPFS), ADT-free survival (ADT-FS) and time-to-next intervention (TTNI). Results: Of the 66 OPC patients analyzed, 25 (38%) men presented as synchronous OPC and the remaining 41 had recurrent OPC. Median and mean follow-up was 61 and 66 weeks, respectively. Patient and disease factors as listed in the Table. Crude Grade 1 and 2 acute toxicities were 36% and 11%, respectively, with no Grade > 2 toxicity. SABR was delivered to 134 metastases: 89 bone (66%), 40 nodal (30%) and 5 (4%) visceral metastases. Overall LPFS at 1-year was 92%. The bPFS and DPFS at 1-year were 69% and 69%, respectively. Median TTNI was not reached yet. Of the 18 men with hormone sensitive prostate cancer who had their ADT deferred, 11/18 (56%) remain free of disease following SABR (1-year ADT-FS was 78%) and in 17 castration resistant men, 11 had > 50% PSA declines with 1-year TTNI of 30% with a median of 45 weeks. Conclusions: Consolidative SABRfor OPCis feasible and well tolerated. The preliminary clinical outcomes in our series is limited by heterogeneity and size but our data suggests that this approach is worthy of further prospective study. [Table: see text]

scholarly journals Upfront metastasis-directed therapy in oligorecurrent prostate cancer does not decrease the time from initiation of androgen deprivation therapy to castration resistance

2021 ◽  
Vol 38 (6) ◽  
Author(s):  
Luca Triggiani ◽  
Rosario Mazzola ◽  
Davide Tomasini ◽  
Alessio Bruni ◽  
Giulia Alicino ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Castration Resistance ◽  
Free Survival ◽  
Local Progression ◽  
Psma Pet ◽  
Pet Ct ◽  
Sensitive Phase

AbstractThe aim of the present study was to explore the potential impact of upfront metastases-directed therapy (MDT) in terms of prolongation of castration-sensitive phase in a series of oligorecurrent castration-sensitive prostate cancer (PC) patients. The present article is a multicenter retrospective study. The population of interest was castrate-sensitive oligorecurrent PC, defined as the presence of 1–3 uptakes in non-visceral sites such as bones or nodes detected by means of 18F-Choline PET/CT or 68-Gallium PSMA PET/CT. Primary endpoint was the time to castration resistance. Secondary endpoints were ADT-free survival, local progression-free survival, and overall survival. Eighty-two patients and 118 lesions were analyzed. The median time to castration resistance for the entire population of the study was 49 months (95% CI 43.6–54.4 months). The 1- and 2-year TTCR-free survival rates were 94% and 82%, respectively. At the time of analysis, 52 patients were still in the castration-sensitive phase of the disease. In this cohort of patients, the median ADT-free survival was 20 months (range 3–69 months). On the other hand, during follow-up 30 patients switched to the castration-resistant phase of disease. In this last group of patients, the median ADT-free survival was 20 months (range 4–50 months). After the ADT administration, the median castration-sensitive phase was 29 months (range 5–71 months). Castration resistance generally occurs at a median follow-up of 24–36 months following ADT. In the current study, upfront MDT does not decrease the time from initiation of ADT to castration resistance.

scholarly journals Surgery plus chemotherapy versus chemotherapy alone in primary intestinal lymphoma: a meta-analysis

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110568
Author(s):  
Yefei Shu ◽  
Xiaofeng Xu ◽  
Wei Yang ◽  
Ling Xu
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Intestinal Lymphoma ◽  
Free Survival ◽  
Random Effects Models ◽  
Systemic Treatments ◽  
Intestinal Lymphomas

Objective Primary intestinal lymphomas (PILs) are uncommon tumors, but their incidence is increasing. Currently, their management is centered around systemic treatments, such as chemotherapy and radiotherapy, whereas surgery is restricted to selected indications. This meta-analysis aimed to evaluate the role of surgery in PIL treatment. Methods We collected publications comparing surgery plus chemotherapy versus chemotherapy alone in patients with PIL from 2000 to 2021. All trials analyzed the summary odds ratios (ORs) of endpoints, including the 5-year overall survival (OS), 3-year OS, and 3-year progression-free survival rates. Combined pooled ORs were analyzed using fixed- or random-effects models according to heterogeneity. Results Six studies were included. Compared with chemotherapy alone, surgery plus chemotherapy was associated with significantly higher 5-year OS [OR = 4.88, 95%confidence interval (CI) = 1.91–12.44, Z = 3.32], 3-year OS (OR = 3.83, 95%CI = 2.33–6.30, Z = 5.30), and 3-year progression-free survival (OR = 3.51, 95%CI = 2.20–5.58, Z = 5.29). Conclusions Surgery plus chemotherapy was associated with better outcomes than chemotherapy alone, especially in the early stages. Therefore, surgery plus chemotherapy may be the preferred strategy for appropriately selected patients with PIL. The protocol for this systematic review was registered at INPLASY (INPLASY202180102) and is available in full ( https: //doi.org/10.37766/inplasy2021.8.0102 ).

scholarly journals Treating the patient and not just the cancer: therapeutic burden in prostate cancer

2021 ◽  
Author(s):  
Daniel E. Spratt ◽  
Neal Shore ◽  
Oliver Sartor ◽  
Dana Rathkopf ◽  
Kara Olivier
Keyword(s):  
Prostate Cancer ◽  
Second Generation ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Patient Treatment ◽  
Free Survival ◽  
Androgen Ablation ◽  
Therapeutic Benefits ◽  
Age Related ◽  
Concomitant Medications

Abstract Background Prostate cancer (PC) is a leading cause of death in older men. Androgen deprivation therapy (ADT) is considered the standard-of-care for men with locally advanced disease. However, continuous androgen ablation is associated with acute and long-term adverse effects and most patients will eventually develop castration-resistant PC (CRPC). The recent approval of three, second-generation androgen receptor inhibitors (ARIs), apalutamide, enzalutamide, and darolutamide, has transformed the treatment landscape of PC. Treatment with these second-generation ARIs have produced positive trends in metastasis-free survival, progression-free survival, and overall survival. For patients with non-metastatic CRPC, who are mainly asymptomatic from their disease, maintaining quality of life is a major objective when prescribing therapy. Polypharmacy for age-related comorbidities also is common in this population and may increase the potential for drug–drug interactions (DDIs). Method This review summarizes the multiple factors that may contribute to the therapeutic burden of patients with CRPC, including the interplay between age, comorbidities, concomitant medications, the use of ARIs, and financial distress. Conclusions As the treatment landscape in PC continues to rapidly evolve, consideration must be given to the balance between therapeutic benefits and potential treatment-emergent adverse events that may be further complicated by DDIs with concomitant medications. Patient-centered communication is a crucial aspect of alleviating this burden, and healthcare professionals (HCPs) may benefit from training in effective patient communication. HCPs should closely and frequently monitor patient treatment responses, in order to better understand symptom onset and exacerbation. Patients also should be encouraged to participate in exercise programs, and health information and support groups, which may assist them in preventing or mitigating certain determinants of the therapeutic burden associated with PC and its management.

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