scholarly journals Diagnostic and Therapeutic Challenges in a Patient with Synchronous Very High-Risk Prostate Adenocarcinoma and Anal Carcinoma

2022 ◽  
Vol 29 (1) ◽  
pp. 377-382
Author(s):  
Jonathan Wallach ◽  
Irini Youssef ◽  
Andrea Leaf ◽  
David Schwartz
Keyword(s):  
High Risk ◽  
Early Stage ◽  
Anal Carcinoma ◽  
Benign Prostatic Hypertrophy ◽  
Prostate Adenocarcinoma ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Brachytherapy Boost ◽  
History Of ◽  
Very High

A 79-year-old HIV-negative Caucasian man with a medical history of smoking 20 pack-years (quit 40 years prior), early-stage non-small cell lung cancer status post-lobectomy 13 years earlier at an outside hospital without evidence of recurrence, and benign prostatic hypertrophy was diagnosed with synchronous very high-risk prostate adenocarcinoma and early-stage anal basaloid squamous cell carcinoma. He proceeded to undergo concurrent treatment for these tumors, consisting of androgen deprivation therapy, external beam radiation therapy, and a brachytherapy boost for the prostate adenocarcinoma; for the anal carcinoma, he was treated with definitive chemoradiation. Over 3.5 years since the completion of radiotherapy, he remains in clinical and biochemical remission.

13-year oncologic and functional outcomes and morbidity in men

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 121-121
Author(s):  
Daniel Shasha ◽  
Robert Salant ◽  
Ahalya Sivathayalan ◽  
Patrick Farrell ◽  
Philippa Cheetham ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Young Patients ◽  
Androgen Deprivation ◽  
Oncologic Outcomes ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
External Beam Irradiation ◽  
Very High

121 Background: Young patients are most often recommended prostatectomy because few radiation series have reported long-term outcomes specifically for this age group. We now address that deficit by presenting single-institution 13-year oncologic outcomes and morbidity after I-125 prostate brachytherapy (BRT). Methods: Between 1998-2014, 227 patients < 55 years were prospectively followed after PCa treatment with BRT +/- external-beam irradiation +/- androgen deprivation. NCCN risk stratification identified 99 low-, 51 intermediate-, 77 high- + very-high-risk patients treated. Endpoints include Phoenix biochemical control (BC), prostate-cancer-specific survival (PCSS), overall survival (OS), and urinary, bowel, and sexual complications. Results: With a minimum and median follow-up of 26 and 72.3 months, respectively the 13-year actuarial rate of BC, PCSS, and OS for low-risk disease: 97.8%, 100%, 100%, respectively; for intermediate-risk disease: 94.0%, 100%, 88.1%, respectively and for high + very-high-risk disease 83.6%, 89.9%, 77.6%, respectively. Only 3 patients died of prostate cancer. Multivariate analysis demonstrated race, EBRT use, ADT use, PSA > 10, PSA > 20, GS > 7, T3a, T3b, smoking, diabetes as significant for BC and PCSS (p < 0.05). Permanent incontinence occurred only in the one patient who underwent TURP, 4 transient urethral strictures were all successfully dilated, and no other grade 3 intestinal or urinary complications were reported. In the 77.5 % potent at baseline, preservation was reported at 5 and 10-years overall in 75.8 % and 54.6 %, and with PDE5-I, 83.3% preserved potency at 10-years. Conclusions: Patients < 55 years achieve excellent and durable prostate cancer control at 13 years after I125 BRT, most notably in high-risk, with prostate cancer specific mortality uncommon in all but very-high-risk group. Significant urinary or bowel morbidity is uncommon, and potency preservation is expected with PDE5-I. We conclude age < 55 years should not be used to discriminate against LDRBT.

External beam radiation therapy and brachytherapy boost versus radical prostatectomy and adjuvant radiation therapy for high-risk prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 21-21 ◽  
Author(s):  
Vinayak Muralidhar ◽  
Brandon Arvin Virgil Mahal ◽  
David Dewei Yang ◽  
Jonathan Eric Leeman ◽  
Anthony Victor D'Amico ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Brachytherapy Boost

21 Background: Previous studies have suggested that combination external beam radiation therapy (EBRT) with brachytherapy boost (BT) for high-risk prostate cancer is associated with equivalent overall survival (OS) compared with radical prostatectomy (RP). However, it is not known whether RP with post-operative radiation therapy (PORT) can offer improved OS compared with combination RT (EBRT + BT + androgen deprivation therapy [ADT]) for patients with Gleason 9-10 high-risk disease. Methods: We identified all patients diagnosed with clinical T1-T3, Gleason 9-10, prostate-specific antigen (PSA) 0-40 ng/mL, and clinically node negative disease between 2004 and 2014 from the National Cancer Database. We divided patients into 4 treatment groups: EBRT + ADT, combination RT (EBRT + BT + ADT), RP, and RP + PORT. Only patients who received PORT within 360 days of surgery were included within the RP + PORT group. We compared OS utilizing inverse probability of treatment-weighted multivariable Cox proportional hazards regression modeling after accounting for clinical and demographic factors, including Gleason grade (9 versus 10), T-stage (T1, T2, T3), age, Charlson-Deyo comorbidity score (0, 1, versus 2), education quartile, income quartile, geographic location within the US, insurance status, facility volume, and race. Results: Median follow-up in the entire cohort was 4.5 years. The numbers of patients treated with EBRT + ADT, EBRT + BT + ADT, RP, RP + PORT were 6778, 924, 7111, and 1929, respectively. There were no significant differences in 5-year OS when comparing combination RT to RP (85.0% vs 85.7%, adjusted hazard ratio (AHR) 0.92, 95% confidence interval [CI] 0.77-1.10, p = 0.36) or RP + PORT (85.0% vs 85.6%, AHR 0.89, 95% CI 0.71-1.12, p = 0.34). Combination RT was associated with superior 5-year OS compared to EBRT + ADT alone (without BT boost) (85.0% vs 79.4%, AHR 1.26, 95% CI 1.07-1.48, p < 0.01). Conclusions: Our study suggests that for patients with Gleason 9-10 tumors, multi-modality surgical therapy is equivalent to combination RT.

Impact of different adjuvant radiotherapy modalities on women with early-stage intermediate- to high-risk endometrial cancer

2019 ◽  
Vol 29 (8) ◽  
pp. 1264-1270
Author(s):  
Meng Jin ◽  
Xiaorong Hou ◽  
Xiansun Sun ◽  
Yuelun Zhang ◽  
Ke Hu ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endometrial Cancer ◽  
High Risk ◽  
Early Stage ◽  
External Beam Radiation Therapy ◽  
Stage I ◽  
External Beam Radiation ◽  
Survival Outcomes ◽  
External Beam ◽  
Beam Radiation

ObjectiveVaginal brachytherapy was recommended for patients with intermediate-risk endometrial cancer, however, optimal radiotherapy modalities for intermediate-high- or high-risk patients remains controversial. Previous studies have mainly focused on survival outcomes and have seldom taken cost issues into consideration, especially for high-risk patients. The purpose of this study is to compare the survival outcomes and costs associated with two adjuvant radiotherapy modalities in the management of patients with early-stage, intermediate- to high-risk endometrial cancer.MethodsAccording to ESMO-ESCO-ESTRO criteria, 238 patients with stage I/II, intermediate- to high-risk endometrial cancer who underwent radiotherapy from January 2003 to December 2015 at our institution were reviewed. The vaginal brachytherapy group and external beam radiation therapy combined with the vaginal brachytherapy group were propensity score-matched at a 1:1 ratio. The Kaplan–Meier method and Cox proportional hazards regression model were used.ResultsA total of 361 patients met our inclusion criteria, the median age of the patients was 58 years (range, 28–85). All were diagnosed with stage I–II endometrial cancer (324 with stage I and 37 with stage II; 350 with endometrioid adenocarcinoma; and 10 with mucinous carcinoma). The median follow-up time was 60.5 months (range, 3–177). Among 119 matched pairs, no significant differences were found in overall (10.9% vs 8.4%, P=0.51), locoregional (4.2% vs 1.7%, P=0.45), or distant recurrence rates (6.7% vs 6.7%, P=1.0) between the two groups. There were also no differences in the 5-year overall (94.8% vs 93.9%, P=0.78) or progression-free survival (90.0% vs 84.4%, P=0.23) between the two groups. The rates of acute and late toxicity were significantly higher in the external beam radiation therapy combined with vaginal brachytherapy vs the vaginal brachytherapy group (all P<0.05), except for the acute hematological toxicity rate (17.6% vs 9.2%, P=0.06). External beam radiation therapy combined with vaginal brachytherapy had a higher median cost ($2759 vs $937, P<0.001) and longer median radiotherapy duration (41 days vs 17 days, P<0.001) than vaginal brachytherapy.ConclusionVaginal brachytherapy was associated with similar local control and long-term survival outcomes relative to the combination of external beam radiotherapy and vaginal brachytherapy and it also minimizes radiation-related complications, reduces medical costs, and shortens radiotherapy duration. Vaginal brachytherapy may be the optimal radiation modality for patients with early-stage endometrial cancer at intermediate to high risk.

scholarly journals Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Manon Dubois ◽  
Henry Abi Rached ◽  
Alexandre Escande ◽  
Frédéric Dezoteux ◽  
Franck Darloy ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Early Stage ◽  
Cox Model ◽  
Combined Treatment ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
Merkel Cell ◽  
Beam Radiation ◽  
Metastatic Relapse

Abstract Purpose Early stage Merkel cell carcinoma (MCC) is a rare and aggressive primary skin cancer. The standard of care for MCC is broad excision and adjuvant external beam radiation therapy (EBRT). However, for some patients, anesthesia is contraindicated, while others run the risk of serious aesthetic sequelae. In such cases, exclusive radiotherapy is an interesting alternative to surgery. Though limited data is available, this study evaluates exclusive radiotherapy for MCC, using data from the largest retrospective study to date. Methods All patients who were followed in our center between 1989 and 2019 for histologically proven early stage MCC were included in the study. They were treated either by surgery with a 2-cm clear margin followed by adjuvant radiotherapy (RT) or by exclusive RT. Survival rates with adjuvant and exclusive EBRT were analyzed using Cox model and Fine and Gray model depending on the type of survival. p value < 0.05 was considered significant. Results Eighty-four patients treated for MCC were included. Fifty-three of them (63.1%) were treated by exclusive RT, and 31 (36.9%) had surgical excision followed by adjuvant RT. Local relapse rate was 13.7% (95% CI 8.0–43.7) in the RT monotherapy group (group A) and 25.8% (95% CI 10.3–56.2) in the surgery + RT group (group B) (p = 0.42). No statistical difference was found for nodal relapse (p = 0.81), metastatic relapse (p = 0.10), disease free survival (p = 0.83) or overall survival (p = 0.98). Conclusion Our study suggests that exclusive radiotherapy for early Merkel cell carcinoma leads to a similar oncological outcome as combined treatment, with fewer aesthetic sequelae. The approach is interesting for elderly patients with comorbidities or patients for whom surgery would cause significant functional or aesthetic sequelae.

Abstract P019: A Single Model For Predicting Major Adverse Cardiovascular Events In Individuals With And Without History Of Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk In Communities (aric) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Yejin Mok ◽  
Lena Mathews ◽  
Ron C Hoogeveen ◽  
Michael J Blaha ◽  
Christie M Ballantyne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Risk Stratification ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Single Model ◽  
History Of ◽  
Very High

Background: In the 2018 AHA/ACC Cholesterol guideline, risk stratification is an essential element. The use of a Pooled Cohort Equation (PCE) is recommended for individuals without atherosclerotic cardiovascular disease (ASCVD), and the new dichotomous classification of very high-risk vs. high-risk has been introduced for patients with ASCVD. These distinct risk stratification systems mainly rely on traditional risk factors, raising the possibility that a single model can predict major adverse cardiovascular events (MACEs) in persons with and without ASCVD. Methods: We studied 11,335 ARIC participants with (n=885) and without (n=10,450) a history of ASCVD (myocardial infarction, ischemic stroke, and symptomatic peripheral artery disease) at baseline (1996-98). We modeled factors in the PCE and the new classification for ASCVD patients (Figure legend) in a single CVD prediction model. We examined their associations with MACEs (myocardial infarction, stroke, and heart failure) using Cox models and evaluated the discrimination and calibration for a single model including those factors. Results: During a median follow-up of 18.4 years, there were 3,658 MACEs (3,105 in participants without ASCVD). In general, the factors in the PCE and the risk classification system for ASCVD patients were associated similarly with MACEs regardless of baseline ASCVD status, although age and systolic blood pressure showed significant interactions. A single model with these predictors and the relevant interaction terms showed good calibration and discrimination for those with and without ASCVD (c-statistic=0.729 and 0.704, respectively) (Figure). Conclusion: A single CVD prediction model performed well in persons with and without ASCVD. This approach will provide a specific predicted risk to ASCVD patients (instead of dichotomy of very high vs. high risk) and eliminate a practice gap between primary vs. secondary prevention due to different risk prediction tools.

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